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Male involvement in prevention programs of mother to child transmission of HIV: a systematic review to identify barriers and facilitators

Frederick Morfaw1*, Lawrence Mbuagbaw23, Lehana Thabane34, Clarissa Rodrigues5, Ana-Paula Wunderlich6, Philip Nana1 and John Kunda7

Author Affiliations

1 Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaounde 1, P.O Box 1364, Yaounde, Cameroon

2 Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Henri Dunant Avenue, Messa, PO Box 87, Yaoundé, Cameroon

3 Departments of Clinical Epidemiology and Biostatistics, Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada

4 Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, ON, Canada

5 Research and Innovation Coaching Program, Department of Surgery at Duke University, Durham, North Carolina, USA

6 Faculty of Inga, Maringa State University, Maringa Area, Brazil

7 Community Information and Epidemiological Technologies (CIET) Zambia, Lusaka, Zambia

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Systematic Reviews 2013, 2:5  doi:10.1186/2046-4053-2-5

Published: 16 January 2013

Abstract

Background

Many reports point to the beneficial effect of male partner involvement in programs for the prevention of mother-to-child-transmission (PMTCT) of HIV in curbing pediatric HIV infections. This paper summarizes the barriers and facilitators of male involvement in prevention programs of mother-to-child-transmission of HIV.

Methods

We searched PubMed, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies published in English from 1998 to March 2012. We included studies conducted in a context of antenatal care or PMTCT of HIV reporting male actions that affected female uptake of PMTCT services. We did not target any specific interventions for this review.

Results

We identified 24 studies from peer-reviewed journals; 21 from sub-Saharan Africa, 2 from Asia and 1 from Europe. Barriers to male PMTCT involvement were mainly at the level of the society, the health system and the individual. The most pertinent was the societal perception of antenatal care and PMTCT as a woman’s activity, and it was unacceptable for men to be involved. Health system factors such as long waiting times at the antenatal care clinic and the male unfriendliness of PMTCT services were also identified. The lack of communication within the couple, the reluctance of men to learn their HIV status, the misconception by men that their spouse’s HIV status was a proxy of theirs, and the unwillingness of women to get their partners involved due to fear of domestic violence, stigmatization or divorce were among the individual factors.

Actions shown to facilitate male PMTCT involvement were either health system actions or factors directly tied to the individuals. Inviting men to the hospital for voluntary counseling and HIV testing and offering of PMTCT services to men at sites other than antenatal care were key health system facilitators. Prior knowledge of HIV and prior male HIV testing facilitated their involvement. Financial dependence of women was key to facilitating spousal involvement.

Conclusions

There is need for health system amendments and context-specific adaptations of public policy on PMTCT services to break down the barriers to and facilitate male PMTCT involvement.

Trial Registration

The protocol for this review was registered with the International prospective register of systematic reviews (PROSPERO) record CRD42011001703.

Keywords:
Male; Partner; Involvement; HIV; PMTCT; Barriers; Facilitators