Antenatal Couple Counseling Increases Uptake of Interventions to Prevent HIV-1 Transmission

Category 1

This was a prospective cohort study where women attended an antenatal clinic and were provided information about the risk of HIV transmission and the availability of VCT at the site. Women were encouraged to inform their male partners of the availability of VCT. Women were asked to return to the facility and were given the option of VCT with or without their partner. Based on their preference, participants were provided pre-test counseling and testing individually or as a couple and again provided the same options at post-test counseling. Counseling was provided by an HIV positive peer counselor. All participants were asked to return after their initial post-test counseling and received additional information about breastfeeding, alternative feeding for infants, nevirapine at delivery, and given nevirapine when appropriate. HIV infected women were evaluated postpartum to assess nevirapine usage and HIV status of infants and given additional counseling. Questionnaires were used to evaluate the characteristics of the participants, presentation at VCT with or without partner, partner notification of test results, nevirapine use, infant feeding practices, and condom use.

Goal of the Practice
  • To evaluate if couple counseling in an antenatal setting could increase the uptake of HIV prevention interventions such as the use of nevirapine at delivery, avoidance of breast feeding, and condom use.
Core Components
  • Women attending ANC were provided information about HIV and VCT availability for themselves and their male partners.
  • Women attending ANC were encouraged to return with their male partners for VCT.
  • Counseling was conducted by peer HIV positive counselor.
  • Participants were provided the option of individual or couple counseling at both pre-test and post-test counseling.
Noteworthy Results
  • Overall, HIV positive women who present for ANC and whose male partners participated in VCT were more likely to receive nevirapine, avoid breastfeeding, and use condoms. This was even greater for participants who received couples counseling.
  • More women, 83%, who were counseled as a couple, returned to receive nevirapine compared to women who were counseled individually (71%) and women whose partner did not come for VCT (56%).
  • Couple counseling showed an increased trend of condom use among women who tested HIV positive.
  • More women who were counseled as a couple, 38%, were more likely to choose not to breastfeed compared to women who were counseled individually.
  • Providing couple counseling and encouraging women to bring their partners for VCT is believed to have improved partner notification rates which were higher in this study, 64%, than in other African studies, 40%.
Lessons Learned
  • Offering couple CT in the antenatal setting provides an opportunity to integrate CT into ANC.
  • Women whose partners participate in CT were more likely to report behaviors that prevent HIV transmission.
  • Couples counseling and testing appears to have a greater effect on behaviors that prevent HIV transmission than individual counseling and testing.
  • There is a need to explore ways to increase male partner participation: only 15% of women who were tested had partners come for VCT and less than half of these women received post-test counseling as a couple.
Focus Areas
Counseling and Testing
PMTCT
Implemented By
Farquhar, Univ of Washington, EGPAF, AIDS Int'l Training and Research Program
Participating Organization
N/A
Region
Africa
Country
Kenya
Environment
Clinic/Health facility
Setting
Urban
Target Population
Adults (over 18)
Scope
1000 - 5000
Implementation Years
09/2001 - 01/2010