Role of male partner involvement in ART retention and adherence in Malawi’s Option B+ program

ABSTRACT

Malawi’s Option B+ program provides all HIV-infected pregnant women free lifelong antiretroviral therapy (ART), but challenges remain regarding retention and ART adherence, potentially due to male partner barriers. We explored relationships between male partner involvement and Option B+ retention and adherence. In 2014, a randomized controlled trial in Malawi compared male recruitment strategies for couple HIV testing and counseling (cHTC) at an antenatal clinic. This secondary analysis was conducted among the entire cohort (N = 200) of women, irrespective of randomization status. We assessed whether cHTC attendance, early disclosure of HIV-positive status, and partner ART reminders were associated with retention and adherence at one month after starting treatment. Retention was defined as attending HIV clinic follow-up within one day of running out of pills. Adherence was defined as taking ≥95% of ARTs by pill count. We used binomial regression to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Median female age was 26 years. Most women (79%) were retained; of these, 68% were adherent. Receiving cHTC was associated with improved retention (aRR 1.33, 95% CI 1.12, 1.59). Receiving male partner ART reminders was weakly associated with retention (aRR 1.16, 95% CI 0.96, 1.39). Disclosure within one day was not associated with retention (aRR 1.08, 95% CI: 0.91, 1.28). Among those who were retained, these three behaviors were not associated with improved 95% adherence. CHTC could play an important role in improving Option B+ retention. Increasing cHTC participation and enhancing adherence-related messages within cHTC are important.

KEYWORDS:

• Partner involvement
• option B+
• retention
• adherence
• PMTCT

Acknowledgements

We would like to acknowledge the contributions of Edward Jere, Lusubiro Paile, Kondwani Kumwenda, Christopher Stanley, Innocent Mofolo, Wingston Ng’ambi, Sarah Chirwa, and Sophie Mtombosola to the main study. We would like to thank our dedicated study staff, the couples who shared their stories, and the Lilongwe District Health Office.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Austin Wesevich http://orcid.org/0000-0001-5202-1231

Additional information

Funding

This work was supported by the University of North Carolina at Chapel Hill Center for AIDS Research  under [grant number P30AI50410]; UNC Hopkins Morehouse Tulane Fogarty Global Health Fellows Program under [grant number R25 TW009340]; National Institute of Mental Health under [grant number K99 MH104154-01A1]; Eunice Kennedy Shriver National Institute of Child Health and Human Development under [grant number R01HD080485]; and Doris Duke Charitable Foundation [grant number 2012087] International Clinical Research Fellows Program at University of North Carolina at Chapel Hill.