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Male Partner Linkage to Clinic-Based Services for Sexually Transmitted Infections and Human Immunodeficiency Virus Services Following Couple Home-Based Education and Testing

Mark, Jennifer MPH, PhD*; Kinuthia, John MBChB, MMed, MPH†,‡,§; Osoti, Alfred O. MBChB, MMed, PhD, MPH*,‡,§; Gone, Molly A. BSc, MPH§; Asila, Victor BSc§; Krakowiak, Daisy PhD, MPH*; Sharma, Monisha PhD, MPH*; Parikh, Saloni BS¶,∥; Ton, Quy T. MD, MPH**; Richardson, Barbra A. PhD††,‡‡; Farquhar, Carey MD, MPH*,‡‡,§§; Roxby, Alison C. MD, MSc§§

doi: 10.1097/OLQ.0000000000001057
Original Studies

Background Home-based human immunodeficiency virus (HIV) testing and education has increased HIV test uptake and access to health services among men. We studied how a home-based antenatal intervention influenced male partner utilization of clinic-based HIV and sexually transmitted infection (STI) services, linkage to HIV care and medical circumcision.

Methods We conducted a secondary analysis within a randomized controlled trial of pregnant women attending antenatal care in Kenya. Women and their male partners received either a home-based couple intervention or an invitation letter for clinic-based couple HIV testing. The home-based intervention included education on STI symptoms, STI and HIV treatment and male circumcision for HIV prevention. Male self-reported outcomes were compared using relative risks at 6 months postpartum.

Results Among 525 women, we reached 487 (93%) of their male partners; 247 men in the intervention arm and 240 men in the control arm. Men who received the intervention were more likely to report an STI consultation (n = 47 vs. 16; relative risk, 1.59; 95% confidence interval, 1.33–1.89). Among 23 men with newly diagnosed HIV, linkage to HIV care was reported by 4 of 15 in the intervention (3 men had missing linkage data) and 3 of 5 men in the control arms (relative risk, 0.66; 95% confidence interval, 0.34–1.29). Although the intervention identified 3 times more men with new HIV infection, the study lacked power to find significant differences in linkage to HIV care. Few eligible men sought medical circumcision (4 of 72 intervention and 2 of 88 control).

Conclusions Home-based couple education and testing increased STI consultations among male partners of pregnant women, but appeared insufficient to overcome the barriers involved in linkage to HIV care and medical circumcision.

Home-based couple education and testing increased sexually transmitted infection consultations among male partners of pregnant women, but appeared insufficient to overcome the barriers involved in linkage to human immunodeficiency virus care and medical circumcision.

From the *Department of Epidemiology, University of Washington, Seattle, WA

Department of Research and Programs

Department of Reproductive Health, Kenyatta National Hospital

§Department of Obstetrics and Gynaecology, University of Nairobi; Nairobi, Kenya

Computer Science and Engineering and Public Health

Department of Public, Health University of Washington, Seattle, WA

**Allina Health, Minneapolis, MN

††Department of Biostatistics

‡‡Department of Global Health

§§Department of Medicine, University of Washington, Seattle, WA

Acknowledgments: The authors would like to thank the clinical, outreach, and administrative staff for their work on this study, with special thanks to Felix A. Otieno, Michael O. Obuong, and Allan Oduor. The authors graciously thank Kisumu County Hospital as well as the participants who made this study possible.

Conflicts of Interest: none declared.

Presented in part at the annual University of Nairobi STD/HIV/SRH Collaborative Meeting, 2017, Nairobi. Presented as a poster at the Conference on Retroviruses and Opportunistic Infections 2019 in Seattle.

Sources of grant funding: This study was made possible by the generous support of the National Institutes of Health [R01 HD 075108-01]. J.M. received funding from the NIH Fogarty International Center Northern Pacific Global Health Fellows Program [Research Training grant R25-TW009345], Boren International Fellowships, and International and Foreign Language Education [P015B100200]. A.O. was supported by the Fogarty International Center and the Office of Research on Women's Health (ORWH) of the National Institutes of Health under Award Number K43 TW010363. D.K. received support from Achievement Rewards for College Scientists (ARCS) Fellowship, the University of Washington Top Scholar Award and Global Opportunities Health Fellowship (GO Health).

Correspondence: Jennifer Mark, MPH, PhD, Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195. E-mail:

Received for publication April 20, 2019, and accepted August 19, 2019.

Online date: August 28, 2019

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