7th December 2011 Symposium ANRS HIV testing among male partners Coverage, associated factors and prenatal intervention in Cameroon ANRS Prenahtest Trial François Dabis, Patrice Tchendjou and Joanna Orne-Gliemann

 HIV counselling and testing = cornerstone of HIV prevention  Low coverage of HIV testing among men : 17 % (WHO, 2010)  Low partner HIV testing rates (% among partners of women tested during prenatal care): 12.5 % Tanzania (Msuya, 2008), 16 % Kenya (Katz, 2009)  Men play a key role in the success of PMTCT programmes as they influence acceptability of HIV testing, adherence to anti-retroviral prophylaxis and to adequate infant feeding practices (Farquhar, 2004, Kiairie 2004) Men and HIV testing

What could be a simple strategy that could both help men access HIV testing and improve men’s involvement in PMTCT?  Use existing infrastructures and easy accessible populations => A clinic-based intervention, targeted to pregnant women, but clearly taking into account her conjugal relationship

 Objectives: encourage women to suggest HIV testing and couple HIV counselling to their partner (role play min session)  Content: based on American CDC counselling manuals Announcement of results and counselling according to HIV status Definition of the couple relationship Evaluation of the type of communication within the couple (sexuality, reproduction, HIV prevention) Strengthened counselling: on importance of partner HIV counselling and testing and couple HIV counselling Capacity-building: possible strategies to invite the partner to HIV counselling and testing Couple-oriented HIV counselling (COC)

 Feasibility and acceptability of COC (Orne-Gliemann, 2010)  Objectives: Evaluate the effect of COC on: Partner HIV testing and couple HIV counselling Communication, sexual, reproductive and HIV prevention behaviour  Methods: Intervention trial, randomised, multicentre, international Cameroon (Yaoundé), Dominican Republic (Santo Domingo), Georgia (Tbilisi) and India (Pune) Recruitment of pregnant women reporting having a stable partner Individual randomisation: SC (standard counselling) vs COC (intervention) 242 women per group / country, 484 women / country => participants Follow-up until 6 month postpartum Quantitative and qualitative data collection ANRS Prenahtest Trial

N= 476% Age (median - IQR)34 (30 – 42) Education level <10 years – 13 years52.3 ≥ Type of union Married31.2 Free union34.8 Not in union34.0 Living with current partner70.3 Frequent couple communication “about the day”70.0 Ever used male condoms within couple82.4 Ever discussed condoms within couple82.4 Ever discussed HIV within couple89.1 Ever had an STI20.0 ANRS : Key partner characteristics in Yaounde

* Reported by women at enrolment  Proportion of partners ever tested for HIV: 70.6% (N = 476)  Reasons for partner to have been ever tested for HIV*:  self-motivation: 19.3%  medically-related reasons such as blood donation or medical intervention: 21%  clinical symptoms: 8.2%  female partner’s previous pregnancy: 5% ANRS : Baseline partner HIV testing data in Yaounde

* Partner HIV testing reported by women Selection of variables integrated in the final model N = 336% Adjusted odds ratio 95 % confidence interval p Type of union Not in union Married – Free union – Frequent couple communication “about the day” – Ever discussed HIV with partner – Factors associated with history of HIV testing among male partner in Yaoundé*

Cameroon%OR95 % CIp Reported by lab SC (n=245)6,1ref COC (n=239) <0.01 Reported by women SC15.1ref COC Combined indicator* SC15.1ref COC <0.01 * Reported by lab and/or reported by women Intention to treat analysis. Unadjusted OR. ANRS 12127: COC increases HIV testing among male partners in Yaoundé

 High coverage of HIV testing among men in Yaoundé:  Specific urban context  Less common during the pregnancy period  COC = efficient intervention to increase HIV testing among men in the context of prenatal care  Both partners tested during pregnancy => increased acceptability of PTMCT and improved child survival  COC = Enhanced post-test that could easily be integrated within routine PMTCT services and could contribute to couple approach to HIV prevention ▪ Preliminary results: impact of COC on HIV disclosure to partner, couple communication on HIV and condom use within the couple Conclusions - Perspectives

 Sponsor and funders Agence Nationale de Recherches sur le SIDA et les hépatites virales Elizabeth Glaser Pediatric AIDS Foundation  Investigators and coordination Dabis François. ISPED - Université Bordeaux 2 Tchendjou Patrice. Centre Pasteur du Cameroun Desgrées du Loû Annabel. IRD, UMR CEPED Orne-Gliemann Joanna. ISPED  Partners Cameroon : Centre Pasteur du Cameroun (CPC) Dominican Republic : Centro Nacional de Investigaciones en Salud Materno Infantil (CENISMI) Georgia: Maternal and Child Care Union (MCCU) India : PRAYAS Health group ANRS Acknowledgements

Prenahtest Team in Yaoundé, Cameroon