Male engagement strategies effective in improving Option B+ retention in rural Mozambique Carolyn M. Audet*; Erin Graves; Magdalena Bravo; Muktar H. Aliyu; Maria Fernanda Sardella Alvim; Ann F. Green; Yazalde Manuel Chire *presenting author Supported by National Institutes of Health/National Institute of Mental Health K01 MH107255-01, and CDC (PEPFAR): Cooperative agreements # U2GGH002071 and # U2GGH001943

Figure 1. Male Engagement Strategy OBJECTIVES To compare rates of retention among pregnant women and their male partners living with HIV in rural Mozambique who receive the male engagement strategy (MES) intervention vs. those receiving standard of care (SOC). METHODS Retrospective cohort study of women (≥15 years old) enrolled in HIV care and treatment through PMTCT services (2014-2016) 112 PEFPAR supported sites; 6500 pregnant women Friends in Global Health Mozambique TBA counsels pregnant woman Seeks permission to contact partner Pregnant woman visits Traditional Birth Attendant (TBA) TBA contacts Male Champion Male Champion visits male partner TBA accompanies couple to health facility Couple counseled and tested together Couple attends 1st Prenatal Care visit together Male Champion conducts home visits TBA accompanies mother and infant to EID Home-based follow up Figure 1. Male Engagement Strategy

MORTALITY HIV DIAGNOSIS CLINIC ENROLLMENT ART INITIATION RETENTION RESULTS N = 6,500 pregnant women N = 727 male partners Figure 2: Pregnant women have 23% lower hazard risk [0.77 (0.69, 0.86)] of ever missing medication pick up during the first 6 months of care in MES sites (adjusting for district, education, marital status, language, BMI and CD4 cell count). Figure 3: Women who enroll at an MES site that has been operating for at least 7 months are 29% less likely to miss medication pick up than those not in MES sites. Figure 2: ART LTFU among women at MES vs. Non-MES sites Figure 3: ART LTFU by duration of MES implementation MORTALITY HIV DIAGNOSIS CLINIC ENROLLMENT ART INITIATION RETENTION PMTCT VCT Other <4 of 6 monthly visits attended in 6 months no contact for >=60 days from last ART refill Only patients who enrolled in clinic are included Referral Source Pre-ART LTFU Post-ART LTFU Time to ART Initiation CD4 at Enrollment

CONCLUSIONS IMPLICATIONS The male engagement strategy employed in rural Zambézia province has resulted in significant improvements in the retention of pregnant women on ART. Women who attended MES clinics were more likely to remain in care at 6 months in comparison with those attending SOC clinics. The longer a clinical site was included in the MES strategy, the better the retention of pregnant women. Impact on male partner uptake of ART and retention in HIV care (if positive) is less clear and needs to be investigated. Engaging male partners is an important component in any ANC service. Community-based services are essential to overcoming local norms and stigma surrounding male engagement in women’s health. IMPLICATIONS 6.0%: 95%CI 4.3-7.6% 1.6%: 95%CI 1.3-1.9%