Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: A qualitative study from urban Blantyre, Malawi

Abstract Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi.Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data.Results The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate male men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

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Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: A qualitative study from urban Blantyre, Malawi

10.21203/rs.3.rs-18743/v1 ◽

2020 ◽

Author(s):

Doreen Sakala ◽

Moses K. Kumwenda ◽

Donaldson F. Conserve ◽

Bassey Ebenso ◽

Augustine Talumba Choko

Keyword(s):

Qualitative Study ◽

Antenatal Care ◽

Hiv Testing ◽

Randomised Trial ◽

Male Partner ◽

Peer Pressure ◽

Barriers And Facilitators ◽

Cluster Randomised Trial ◽

Hiv Test ◽

Economic Barriers

Abstract BackgroundMale partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi.MethodsData were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data.ResultsThe economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate male men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. ConclusionPeer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

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Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: A qualitative study from urban Blantyre, Malawi

10.21203/rs.3.rs-18743/v3 ◽

2020 ◽

Author(s):

Doreen Sakala ◽

Moses K. Kumwenda ◽

Donaldson F. Conserve ◽

Bassey Ebenso ◽

Augustine Talumba Choko

Keyword(s):

Qualitative Study ◽

Antenatal Care ◽

Hiv Testing ◽

Randomised Trial ◽

Male Partner ◽

Peer Pressure ◽

Barriers And Facilitators ◽

Cluster Randomised Trial ◽

Hiv Test ◽

Economic Barriers

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Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: a qualitative study from urban Blantyre, Malawi

BMC Public Health ◽

10.1186/s12889-020-10112-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Doreen Sakala ◽

Moses K. Kumwenda ◽

Donaldson F. Conserve ◽

Bassey Ebenso ◽

Augustine T. Choko

Keyword(s):

Qualitative Study ◽

Antenatal Care ◽

Hiv Testing ◽

Randomised Trial ◽

Male Partner ◽

Peer Pressure ◽

Barriers And Facilitators ◽

Cluster Randomised Trial ◽

Hiv Test ◽

Economic Barriers

Abstract Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi. Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data. Results The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

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Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: A qualitative study from urban Blantyre, Malawi

10.21203/rs.3.rs-18743/v4 ◽

2020 ◽

Author(s):

Doreen Sakala ◽

Moses K. Kumwenda ◽

Donaldson F. Conserve ◽

Bassey Ebenso ◽

Augustine Talumba Choko

Keyword(s):

Qualitative Study ◽

Antenatal Care ◽

Hiv Testing ◽

Randomised Trial ◽

Male Partner ◽

Peer Pressure ◽

Barriers And Facilitators ◽

Cluster Randomised Trial ◽

Hiv Test ◽

Economic Barriers

Abstract Background: Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi. Methods: Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data. Results: The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate male men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion: Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

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Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: A qualitative study from urban Blantyre, Malawi

10.21203/rs.3.rs-18743/v2 ◽

2020 ◽

Author(s):

Doreen Sakala ◽

Moses K. Kumwenda ◽

Donaldson F. Conserve ◽

Bassey Ebenso ◽

Augustine Talumba Choko

Keyword(s):

Qualitative Study ◽

Antenatal Care ◽

Hiv Testing ◽

Randomised Trial ◽

Male Partner ◽

Peer Pressure ◽

Barriers And Facilitators ◽

Cluster Randomised Trial ◽

Hiv Test ◽

Economic Barriers

Abstract Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi.Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data.Result The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate male men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

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Maternal and infant antiretroviral therapy adherence among women living with HIV in rural South Africa: a cluster randomised trial of the role of male partner participation on adherence and PMTCT uptake

SAHARA-J Journal of Social Aspects of HIV/AIDS ◽

10.1080/17290376.2020.1863854 ◽

2021 ◽

Vol 18 (1) ◽

pp. 17-25

Author(s):

Deborah L. Jones ◽

Violeta J. Rodriguez ◽

Manasi Soni Parrish ◽

Tae Kyoung Lee ◽

Stephen M. Weiss ◽

...

Keyword(s):

Randomised Trial ◽

Male Partner ◽

Cluster Randomised Trial ◽

Rural South ◽

Women Living With Hiv ◽

Cluster Randomised ◽

Antiretroviral Therapy Adherence ◽

Living With Hiv ◽

Rural South Africa

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HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: An adaptive multi-arm, multi-stage cluster randomised trial

PLoS Medicine ◽

10.1371/journal.pmed.1002719 ◽

2019 ◽

Vol 16 (1) ◽

pp. e1002719 ◽

Cited By ~ 26

Author(s):

Augustine T. Choko ◽

Elizabeth L. Corbett ◽

Nigel Stallard ◽

Hendramoorthy Maheswaran ◽

Aurelia Lepine ◽

...

Keyword(s):

Antenatal Care ◽

Financial Incentives ◽

Randomised Trial ◽

Linkage To Care ◽

Cluster Randomised Trial ◽

Male Partners ◽

Care Clinic ◽

Cluster Randomised ◽

Multi Stage ◽

Self Testing

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A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04267-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rohan D. Jeremiah ◽

Dhruvi R. Patel ◽

Ellen Chirwa ◽

Esnath Kapito ◽

Xiaohan Mei ◽

...

Keyword(s):

Health Promotion ◽

Hiv Prevention ◽

Reproductive Health ◽

Antenatal Care ◽

Hiv Testing ◽

Late Pregnancy ◽

Sub Saharan Africa ◽

Partner Communication ◽

Logistic Regression Models ◽

Hiv Test

Abstract Background HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. Methods A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. Results Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. Conclusions HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.

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Barriers and facilitators associated with HIV testing uptake in South African health facilities offering HIV Counselling and Testing

Health SA Gesondheid ◽

10.4102/hsag.v21i0.938 ◽

2016 ◽

Vol 21 ◽

pp. 86-95 ◽

Cited By ~ 6

Author(s):

Neo Mohlabane ◽

Bomkazi Tutshana ◽

Karl Peltzer ◽

Aziza Mwisongo

Keyword(s):

Hiv Testing ◽

South African ◽

Health Workers ◽

Scale Up ◽

Health Facilities ◽

Barriers And Facilitators ◽

Hiv Care ◽

Treatment Needs ◽

Hiv Test ◽

Hiv Counselling And Testing

Background: The scale-up of HIV Counselling and Testing (HCT) in South Africa to 4500 public health facilities and the service's provision in mobile and non-medical sites was aimed at increasing HCT uptake. However, some people still have never had an HIV test.Objective: An HCT survey was carried out to ascertain barriers and facilitators for HIV testing in South Africa.Methods: A cross-sectional survey of 67 HCT-offering health facilities in 8 South African provinces was undertaken. Individuals (n = 489) who had not tested for HIV on the day of the site visit were interviewed on awareness of HCT services, HIV testing history and barriers to HIV testing. Frequencies were run to describe the sample characteristics, barriers and facilitators to HIV testing. Bivariate and multivariate logistic regression was usedt o identify the association between never tested for HIV with socio-demographics, awareness of HCT services and type of HCT facilities.Results: In all 18.1% participants never had an HIV test. Major barriers to HCT uptake comprise being scared of finding out one's HIV test result or what people may say, shyness or embarrassment, avoidance of divulging personal information to health workers and fear of death. In multivariate analysis the age group 55 years and older, and not being recommended to have an HIV test were associated with never had an HIV test. Potential facilitators for HIV testing include community or household HIV testing, providing incentives for those who test for HIV, mandatory HIV testing and disclosure of HIV status by those who test HIV positive.Conclusion: The benefits of HCT which include the reduction of HIV transmission, the availability of HIV care and treatment needs to be emphasized to enhance HCT uptake.

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