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

Farquhar, Carey MD, MPH*†; Kiarie, James N. MBChB, MMed, MPH; Richardson, Barbra A. PhD§¶; Kabura, Marjory N. MBChB; John, Francis N. BSc; Nduati, Ruth W. MBChB, MMed, MPH; Mbori-Ngacha, Dorothy A. MBChB, MMed, MPH; John-Stewart, Grace C. MD, PhD*†

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2004 - Volume 37 - Issue 5 - p 1620-1626
Epidemiology and Social Science

To determine effect of partner involvement and couple counseling on uptake of interventions to prevent HIV-1 transmission, women attending a Nairobi antenatal clinic were encouraged to return with partners for voluntary HIV-1 counseling and testing (VCT) and offered individual or couple posttest counseling. Nevirapine was provided to HIV-1-seropositive women and condoms distributed to all participants. Among 2104 women accepting testing, 308 (15%) had partners participate in VCT, of whom 116 (38%) were couple counseled. Thirty-two (10%) of 314 HIV-1-seropositive women came with partners for VCT; these women were 3-fold more likely to return for nevirapine (P = 0.02) and to report administering nevirapine at delivery (P = 0.009). Nevirapine use was reported by 88% of HIV-infected women who were couple counseled, 67% whose partners came but were not couple counseled, and 45%whose partners did not present for VCT (P for trend = 0.006). HIV-1-seropositive women receiving couple counseling were 5-fold more likely to avoid breast-feeding (P = 0.03) compared with those counseled individually. Partner notification of HIV-1-positive results was reported by 138 women (64%) and was associated with 4-fold greater likelihood of condom use (P = 0.004). Partner participation in VCT and couple counseling increased uptake of nevirapine and formula feeding. Antenatal couple counseling may be a useful strategy to promote HIV-1 prevention interventions.

From the Departments of *Medicine, †Epidemiology, and §Biostatistics, University of Washington, Seattle, WA; Departments of ‡Obstetrics/Gynaecology and Paediatrics, University of Nairobi, Nairobi, Kenya; and ¶Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.

Received for publication October 17, 2003; accepted March 24, 2004.

Funded by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). C. Farquhar is supported by the National Institutes of Health (K23-HD41879). J. Kiarie and F. John were scholars in the AIDS International Training and Research Program supported by the National Institutes of Health/Fogarty International Center (T22-TW00001). G. John-Stewart is an EGPAF Scientist and D. Mbori-Ngacha has an EGPAF Leadership Award.

Reprints: Carey Farquhar, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104-2499 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.