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Male Antenatal Attendance and HIV Testing Are Associated With Decreased Infant HIV Infection and Increased HIV-Free Survival

Aluisio, Adam MS*; Richardson, Barbra A PhD, MS†‡; Bosire, Rose MBChB, MPH§; John-Stewart, Grace MD, PhD‖¶#; Mbori-Ngacha, Dorothy MBChB, MMed, MPH**; Farquhar, Carey MD, MPH‖¶#

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2011 - Volume 56 - Issue 1 - p 76-82
doi: 10.1097/QAI.0b013e3181fdb4c4
Epidemiology and Prevention

Objective: To investigate the relationship between male involvement in prevention of mother-to-child HIV transmission services and infant HIV acquisition and mortality, a prospective cohort study was undertaken between 1999 and 2005 in Nairobi, Kenya.

Methods: HIV-infected pregnant women were enrolled and followed with their infants for 1 year with infant HIV DNA testing at birth, 1, 3, 6, 9, and 12 months postpartum. Women were encouraged to invite male partners for prevention counseling and HIV testing.

Results: Among 456 female participants, 140 partners (31%) attended the antenatal clinic. Eighty-two (19%) of 441 infants tested were HIV infected by 1 year of age. Adjusting for maternal viral load, vertical transmission risk was lower among women with partner attendance compared with those without [adjusted hazard ratio (aHR) = 0.56, 95% confidence interval (CI): 0.33 to 0.98; P = 0.042] and among women reporting versus not reporting previous partner HIV testing (aHR = 0.52, 95% CI: 0.32 to 0.84; P = 0.008). The combined risk of HIV acquisition or infant mortality was lower with male attendance (aHR = 0.55; 95% CI: 0.35 to 0.88; P = 0.012) and report of prior male HIV testing (aHR = 0.58; 95% CI: 0.34 to 0.88; P = 0.01) when adjusting for maternal viral load and breastfeeding.

Conclusions: Including men in antenatal prevention of mother-to-child HIV transmission services with HIV testing may improve infant health outcomes.

From the *Stony Brook University Medical Center, Stony Brook, NY; †Department of Biostatistics, University of Washington, Seattle, WA; ‡Division of Public Health Sciences, Fred Hutchinson Cancer Research Cancer, Seattle, WA; §Kenya Medical Research Institute, Nairobi, Kenya; Departments of ∥Epidemiology; ¶Medicine; and #Global Health, University of Washington, Seattle, WA; and **Department of Paediatrics, University of Nairobi, Nairobi, Kenya.

Received for publication July 9, 2010; accepted September 21, 2010.

Supported by grant HD-23412 from the US National Institute of Child Health and Human Development.

A. Aluisio was a scholar in the International AIDS Research and Training Program and was supported by grant 5 R24 TW007988 from the National Institutes of Health, Fogarty International Center through Vanderbilt University.

Presented orally at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 19-22, 2009, Cape Town, South Africa.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors have no conflicts of interest to disclose.

Correspondence to: Adam Aluisio, MS, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104 (e-mail: adam.aluisio@hsc.stonybrook.edu).

© 2011 Lippincott Williams & Wilkins, Inc.