Male Partners Involvement in Human Immune Deficiency Virus Testing and Counseling in Bichena town: a cross-sectional study

doi:10.21203/rs.3.rs-1764385/v1

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Male Partners Involvement in Human Immune Deficiency Virus Testing and Counseling in Bichena town: a cross-sectional study

https://doi.org/10.21203/rs.3.rs-1764385/v1

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Objective

Transmission of HIV from mother to child remains a significant problem in developing countries. Male partner involvement in HIV testing and counseling is a major entry point for the PMTCT. This study aimed to assess male partner involvement in HIV testing and counseling. A community-based cross-sectional study design was conducted from March 1–15/2019 among 406 male partners. The data were analyzed using the SPSS 23.0 version. Logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 considered statistically significant.

Results

In this study, 41.4% [95% CI: 36.2–46.1%] of male partner was involved in HIV testing and counseling. In multivariable analysis male partners who are found in the age group of 20–29 years, secondary, and diploma and above educational level, good knowledge of the services provided in the ANC visits, male partners whose wife had ≥ 4 ANC visits, knowledge of MTCT and PMTCT, entered the ANC room together with his wife, discussed maternal health issue with health care providers, and traveled < 15 minutes to reach a nearby health facility were associated with male partner involvement in HIV testing and counseling.

Human Immune Deficiency Virus (HIV) counseling and testing is the access point to HIV prevention, care, and treatment programs [1]. Routine antenatal care (ANC) counseling and testing for HIV have been introduced into the prevention of mother-to-child transmission (PMTCT) of HIV programs in resource-limited settings [2, 3]. Mother-to-child transmission (MTCT) is the most common route of infection for HIV-positive children under 5 years [3]. The World Health Organization (WHO) recommends offering HIV testing and counseling (HTC) to couples, wherever HTC is available, including in ANC/PMTCT clinics [4].

Without intervention, the risk of HIV infection from infected pregnant mothers to their unborn children ranges from 25%-35% in developing countries, while with the implementation of core PMTCT interventions, this risk can be reduced to 2–5% [5]. According to the report of different studies conducted in Ethiopia, the prevalence of MTCT of HIV ranges from 4.16–15.7% [6, 7]

Male partner involvement (MPI) in HTC increases the use of PMTCT interventions in resource-limited settings and improved HIV-free survival among infants [8–11]. However, the low MPI in the PMTCT results in pregnant women not getting tested for HIV [12]. A study conducted in Uganda indicates that more than 50% of pregnant women who refused HTC in a PMTCT setting reported the need for male partner (MP) permission before they could be tested [13].

HIV testing and counseling of pregnant women and their MP is essential to initiate early antiretroviral therapy that improves maternal health and decreases the risk of MTCT [2]. MPI in HTC is critical for PMTCT [14]. It has been recognized as an apriority focus area to be strengthened in PMTCT [15, 16].

Knowing the level of MPI in HTC during pregnancy is important for the implementation of the Sustainable Development Goals [17]. Therefore, this study aimed to assess the level of MPI in HTC, and its associated factors in Bichena town, Westcentral, Ethiopia.

Study design and period

A community-based cross-sectional study was conducted from March 1-15/2019 in Bichena town.

Study sitting

This study was conducted in Bichena town, which is located in the East Gojjam Zone of the Amhara Region, Ethiopia. The town has one public primary hospital and one health center, which provide maternal and other health services to the population of the town and the surrounding area [18].

Study participants

All MP whose wives gave birth within the last one year before the study and had ANC visits were included, while MP who were seriously ill were excluded.

Operational definitions

Male partner: Is an individual with whom the pregnant woman was in an intimate sexual relationship, and was responsible for her pregnancy whether they were legally married or not [19].

Male partner involvement in HTC: Refer to the MPI in both HIV counseling and testing during his wife's ANC visit [19].

Knowledge of MTCT: When MP knows at least one route of transmission of MTCT of HIV from three questions, considered as having knowledge of MTCT [19, 20].

Knowledge of PMTCT: When MP knows at least one PMTCT method from the three knowledge measuring items, considered to as having knowledge of PMTCT [19, 20].

Sample size determination and techniques

The sample size was calculated using a single population proportion formula by considering the following assumptions: the proportion of MPI in HTC at Gondar town was (40.1%) [19], Zα/2 = critical value for normal distribution at 95% confidence level, which is equal to 1.96 (Z value of alpha =0.05) or 5% level of significance (α=0.05) and a 5% margin of error (d =0.05). The sample size was adjusted by adding a 10% non-response rate and the final sample size was 406. The study participants were selected by using simple random sampling techniques.

Data collection tools and procedures

The data were collected using structured and pre-tested interviewer-administered questionnaires through face-to-face interviews. The data was collected by five-diploma midwives and supervised by two BSc midwives.

Data quality control

The data collectors and supervisors trained for two days on the objectives, relevance of the study, and techniques of interviews. Daily supervision was done for data completeness.

Data processing, analysis, interpretation, and presentation

The data were entered by using Epi data 3.1, then exported to SPSS version 23.0 for analysis. During analysis, all explanatory variables which have a significant association in bivariate analysis with a P-value <0.20 were entered into a multivariable logistic regression model to get an adjusted odds ratio (AOR), and those variables with 95% of confidence intervals (CI) and a P-value of < 0.05 was considered as statistically significant with MPI in HTC.

Socio-demographic characteristics of the male partners

A total of 406 MP participated with a response rate of 100%. The mean age of the MP was 35.08 years and ranged from 20–60 years. Of the MP, 124 (30.6%) had a diploma and above educational level, and 139 (34.3%) are farmers (Table 1).

Table 1

Socio-demographic characteristic of the MP in Bichena town, Westcentral, Ethiopia, 2019, (n = 406).
Variables	Categories	Frequency	Percentage
Age of male partner	20–29 30–39 40–60	88 216 102	21.7 53.2 25.1
Religion	Orthodox Muslim Protestant	327 68 11	80.5 16.8 2.7
Male partner education level	Had no formal education Primary school Secondary school Diploma and above	89 109 84 124	21.9 26.8 20.7 30.6
Male partner occupation	Employed (public/NGO) Farmer Merchant Driver Others*	95 139 89 39 44	23.4 34.3 21.9 9.6 10.8
Wife education level	Had no formal education Primary school Secondary school Diploma and above	110 114 94 88	27.1 28.1 23.2 21.6
Wife occupation	Housewife Employed (public/NGO) Merchants Others**	235 68 72 31	57.9 16.7 17.7 7.7
Age of male partner at first marriage	15–19 20–24 25–29 ≥ 30	81 144 137 44	20.0 35.5 33.7 10.8
Length of marriage	≤ 10 11–20 ≥ 21	143 187 76	35.2 46.1 18.7
Family size	3–4 ≥ 5	214 192	52.7 47.3
Number of under-five children	One child Two or more children	299 107	73.6 26.4
Is the pregnancy was planned	Yes No	384 22	94.6 5.4
* Driver, daily laborer, and carpenter, ** student, and daily laborer

Knowledge of male partner about the services provided in ANC/PMTCT clinic

Two third (65.8%) of the MP had good knowledge of ANC. Of the MP, 359 (88.4%), 355 (87.4%), 350 (86.2%), and 349 (86.0%) responded that: testing of blood, iron and folic acid supplementation, monitoring of fetal health, and abdominal examination as major services provided in ANC visits respectively. The availability of HTC, and PMTCT knew by 249 (61.3%), and 177 (43.6%) of MP respectively (Table S1).

Involvement in ANC/PMTCT

About, 287 (70.7%) MP was involved in making a joint prior plan for the ANC visit. Of the MP, 214 (52.7%) accompanied their wife to an ANC/PMTCT clinic at least once, and 196 (48.3%) physically entered the ANC/PMTCT room together with their wife. While 135 (33.3%) of MP discussed maternal health issues with the health care providers (Figure S1).

Health care facility and cultural influence

Of the MP, 244 (60.1%) have a health facility nearby to their home, which is taking about 15–30 minutes to reach, and 393 (96.8%) knew that the maternal health service provision at a public health facility is free (Table S2).

Level of male partner involvement in HTC

In this study, 168 (41.4%) with [95% CI = 36.2–46.1) of MP involved in HTC. Of the MP, 249 (61.3%), and 177 (43.6%) knew at least one route of MTCT, and PMTCT methods respectively (Table 2).

Table 2

Level of MPI in HTC in Bichena town, Westcentral, Ethiopia, 2019, (n = 406)
Variables	Categories	Frequency	Percentage
Visited the PMTCT/ANC clinic with his wife at least once	Yes No	214 192	52.7 47.3
Reasons for not accompanying to the PMTCT/ANC clinic, (n = 192)*	The inflexibility of PMTCT/ANC visiting time Work overload Long waiting time ANC/PMTCT is a concern of the women Limited space to accommodate both parents Other family members accompanied her Male feel shame Women do not allow their partners to accompany Do not know pregnancy could result in a complication	165 145 139 88 66 103 45 37 31	85.9 75.5 72.4 45.8 34.4 53.6 23.4 19.3 16.1
Number of male partner ANC visited (n = 214)	1 2 3 4⁺	125 49 26 14	58.4 22.9 12.2 6.5
Numbers of your wife ANC visited	< 3 4⁺	126 280	31.0 69.0
Involved in both testing and counseling of HIV	Yes No	169 238	41.4 58.6
Know about MTCT	Yes No	249 157	61.3 38.7
Timing of MTCT (n = 249)*	During pregnancy During delivery During breastfeeding	146 187 74	58.6 75.1 29.7
Knew about PMTCT	Yes No	177 229	43.6 54.4
Methods of PMTCT (n = 177)*	Anti-retroviral therapy Delivery by Cesarean section Avoiding breastfeeding	158 29 43	89.3 16.4 24.3
* Multiple responses are possible

Factors associated with MPI in HTC

In the multivariable analysis: MP`s who are found in the ages group of 20–29 years, secondary, and diploma and above educational level, having good knowledge of the services provided in ANC visits, knowing at least one timing of MTCT and PMTCT method, entering the ANC/PMTCT clinic together with his wife, discussed maternal health issues with health care providers, whose wives had four and above ANC visit, and traveled < 15 minutes to reach a nearby health facility were significantly associated with MPI in HTC at a P-value of less than 0.05 (Table 3).

Table 3

Logistic regression analysis for the MPI in HTC at Bichena town, Westcentral, Ethiopia, 2019, (n = 406).
Variables	Involved in HTC		COR( 95% CI)	AOR(95% CI)	P-value
Variables	Yes	No	COR( 95% CI)	AOR(95% CI)	P-value
Husband age ≥ 40 30–39 20–29	23 81 64	79 135 24	1 2.06 (1.20–3.54) 9.16 (4.73–17.72)	1 1.59 (0.61–4.17) 4.05 (1.23-113.34)	0.345 0.021*
Husband educational level Had no formal education Primary education Secondary education Diploma and above	11 37 38 82	78 72 46 42	1 3.64 (1.73–7.68) 5.85 (2.73–12.57) 13.84 (6.65–28.80)	1 1.08 (0.31–3.74) 4.13 (1.09–15.67) 5.32 (1.55–18.26)	0.909 0.037* 0.008*
The educational level of the wife Had no formal education Primary education Secondary education Diploma and above	40 65 40 43	70 69 54 54	1 1.14 (0.66–1.96) 1.30 (0.74–2.29) 1.67 (0.95–2.96)	1 0.56 (0.18–1.75) 0.65 (0.21–2.01) 0.53 (0.15–1.87)	0.316 0.455 0.326
Knowledge of male partner on ANC Poor knowledge Good knowledge	19 149	120 118	1 7.95 (4.64–13.70)	1 3.25 (1.13–9.35)	0.029*
Knew at least on the timing of MTCT No Yes	39 129	118 120	1 3.25 (2.10–5.05)	3.17 (1.34–7.49)	0.009*
Knew at least on PMTCT method No Yes	56 112	173 65	1 5.32 (3.47–8.18)	1 2.55 (1.10–5.91)	0.030*
Physically entered the ANC/PMTCT clinic together with his wife No Yes	18 150	192 46	1 34.78 (19.37–62.45)	1 15.77 (6.48–38.35)	0.001*
Numbers of wives ANC visited < 3 times 4⁺	20 148	106 132	1 5.94 (3.49–10.12)	1 3.13 (1.17–8.38)	0.023*
Discussed maternal health issues with health care providers No Yes	52 116	219 19	1 25.71 (14.52–45.54)	1 14.65 (6.44–33.31)	0.001*
Time to reach the nearest health facility > 30 minute 15–30 minute ≤ 15 minute	28 100 40	76 144 18	1 1.88 (1.14–3.12) 6.03 (2.98–12.21)	1 0.81 (0.31–2.13) 3.99 (1.11–14.31)	0.667 0.034*
Decision-maker to seek health facility Ether husband/wife Together	8 160	43 195	1 4.41 (2.01–9.65)	1 1.27 (0.34–4.76)	0.720
*Significant at a P-value of < 0.05

Only screening pregnant mothers are not satisfactory for PMTCT, it is necessary involving MP to improve women's uptake of PMTCT services [21, 22]. This study identified only 41.4% [95% CI: 36.2–46.1%] MP involved in HTC. This finding is in line with a study conducted in Gondar Town (40.1%) [19]. However, the finding of this study is higher than studies conducted in Goba town (22.7%), and Mekelle town (16.5%) [22, 23]. This might be due to the implementation of health extension workers, which may increase the awareness of MP on the advantage of involving in HTC [24, 25]. The finding of this study is lower than studies conducted in Delanta District (53.7%) [26], Arba Minch (53.6%) [27], Debre Markos town (59.1%) [28], and Addis Ababa (63.7%) [29]. The discrepancy might be the differences in the studies setting, and the provision of health care service differs from facility to facility.

Male partners who are found in the age group of 20–29 years were 3.34 times more likely involved in HTC. It is in line with other studies [19, 23]. The possible reason might be those who are found in the age group of 20–29 years are a young age group and the current pregnancy might be their first time becoming a father. Because of this, they may pay more care and attention to their wife. Our study found that MPI in HTC is increased with increasing educational levels. This finding is in line with other studies [10, 27, 30]. Educated men may have more information regarding the advantage of getting the service provided at the health facility.

Entering the PMTCT clinic together with wives increased the MPI in HTC by 15.77 times. It is in line with another study [26]. During the counseling session, they may understand that HTC is the responsibility of both parents. The odds of MPI in HTC were 3.13 times higher among MP whose wives had ≥ 4 ANC visits. This is agreed with another study [26]. Having support from the husband makes the pregnant woman to completion of the ANC visits, which in turn also increases MPI in HTC [31]. MP`s who are discussed maternal health issues with health care providers were 14.65 times more likely involved in HTC. Making a bilateral decision regarding the health of families increases the utilization of health care services [32–34].

Having a health facility nearby to the living home increased MPI in HTC. This is congruent with another study [27]. This might be making the visiting time convenient. Knowing the service provided at the PMTCT clinic increased MPI by 3.25 times. This finding is in line with other studies [10, 27, 35]. The MPI in HTC was 3.17 times higher among MP who knew at least one timing of MTCT. This is consistent with other studies [19, 29, 36]. MP who know at least one PMTCT method were 2.55 times more likely involved in HTC. This finding agrees with other studies [10, 27–29]. Knowing MTCT/PMTCT could increase the MPI in HTC and it may also make them understand that the pregnancy was their shared responsibility.

Male partner involvement in HTC in the study area was low compared to other studies conducted in Ethiopia. Therefore, the health care providers, health extension workers, and community-based volunteers need to continue educating the community about the effects of HIV/ADIS.

This study was not triangulated with the qualitative method

AIDS: Acquired Immune Deficiency Syndromes; ANC: Antenatal Care; AOR: Adjusted Odds Ratio; CI: Confidence Interval; COR: Crude Odds Ratio; HIV: Human Immune Deficiency Virus; HTC: HIV Counseling and Testing; MP: Male Partner; MPI: Male Partner Involvement; MTCT: Mother to Child Transmission; PMTCT: Prevention of Mother to Child Transmission; WHO: World Health Organization.

Ethical Approval and Consent to participate

Ethical clearance was obtained from the Institutional Review Board of Bahir Dar University, College of medicine and health sciences. Letter of the permission was also obtained from Bichena town health office administration for each kebele of the town. The purpose of the study was explained to each male partner. At the time of data collection, written consent was obtained from each study participant. All respondents were assured that the data would not have any negative consequence on any aspects of their life.

Competing interests

The author declares no competing interests

Authors’ Contribution

NAG, GBG, and AMA were responsible for the conception of the research idea, study design, data collection, analysis and interpretation, and supervision. NAG and WFB participated in the data collection, entry, analysis, and manuscript write-up. All authors have read and approved the final manuscript.

Acknowledgments

Firstly, we would like to thank Bahir Dar University College of Medicine and Health Sciences for logistic support for the study. Secondly, we would like to thank the Bichena town health office administrative, for writing letters of permission for each kebele of the town and for giving the necessary information. Finally, we would like to acknowledge the data collectors, supervisors, and study participants for their participation in this study.

Funding

This study was financially supported by Bahir Dar University College of Medicine and Health Sciences.

Consent for publication

Not applicable

Data availability statement

All related data have been presented within the manuscript. The data set supporting the conclusion of this article is available from the corresponding author upon reasonable request.

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Male Partners Involvement in Human Immune Deficiency Virus Testing and Counseling in Bichena town: a cross-sectional study

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Abstract

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Materials And Methods

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Discussion

Conclusion

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