Home Visits during Pregnancy Enhance Male Partner HIV Counseling And Testing In Kenya : A Randomized Clinical Trial

Abstract

Background HIV testing of male partners of pregnant women is important to decrease HIV transmission to women and to support HIV-infected women in taking prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) settings. We hypothesized that home visits to male partners of women attending ANC would be feasible and would increase HIV testing of partners. Methods Pregnant women attending ANC were enrolled, interviewed using smartphone audio-computer assisted self-interviews (ACASI), and randomized to home visits or written invitations for male partners to come to clinic. Enrolled men were interviewed (ACASI) and offered couples HIV counseling and testing (CHCT). Participants underwent follow-up ACASI six weeks post-enrollment. Prevalence of CHCT, male HIV, couple discordance, intimate partner violence were compared using intent-to-treat analysis. Results Among 495 women screened, 312 (63.0%) were eligible, of whom 300 were randomized to clinic-based or home-based HCT. Median age was 22 years [interquartile range (IQR) 20,26]; most were monogamous (87%) and 11% reported condom use and did not differ between trial arms. Male CHCT was substantially and significantly higher in the home-visit than the clinic-invitation arm (87% vs. 36%, p<0.0001). A higher proportion of women in the home-visit than clinic-invitation arm reported improved relationship quality 6 weeks after CHCT (70% vs. 29%, p<0.0001) and there was no increased risk of intimate partner violence or relationship instability. Conclusion Home visits were safe, acceptable, and resulted in more pregnant women and their male partners learning each other's HIV status. This strategy could facilitate efforts to prevent HIV acquisition among pregnant women, improve PMTCT uptake, and accelerate male HIV diagnosis care