Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission

Abstract

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.

FIGURE 1

Enrollment and follow-up of pregnant women.

FIGURE 2

Trends for nevirapine uptake and compliance with nevirapine regimen.

FIGURE 3

Percent of women reporting condom use at baseline and after VCT. A, HIV-1–seropositive women. ¹Significant difference between women who were couple counseled and those not couple counseled (P = 0.07). ²Significant difference between women who informed partners of HIV status and those who did not (P = 0.004). B, HIV-1-seronegative women. ³Significant difference between women whose partners came for VCT vs. did not come (P < 0.001). ⁴Significant difference between women who were couple counseled and those not couple counseled (P < 0.001). Percentages indicate the increase in the proportion of women reporting condom use during follow-up over baseline.