Knowledge of male partner HIV status as a risk factor for HIV indicators in women using prevention of mother-to-child transmission of HIV services in WHO priority countries : a systematic review and meta-analysis
Date
2022-12
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Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Elimination of new maternal and infant Human Immunodeficiency Virus (HIV) cases has been a top global priority and various targets have been introduced to end HIV in pregnant, postpartum women and their infants. To achieve these targets, it is important to understand factors related to unfavourable outcomes in the prevention of mother-to-child transmission of HIV (PMTCT, MTCT) programme cascade. The role of a male partner, especially HIV status non-disclosure is one of several important factors. Our study aimed to determine whether not knowing a male partner’s HIV status was a significant risk factor for HIV indicators, including poor HIV clinical outcomes, among pregnant, postpartum women and their infants in the 21 World Health Organization (WHO) priority countries for eliminating MTCT. We conducted a systematic review and meta-analysis of literature through four electronic databases in April 2022 for eligible studies from the 21 WHO priority countries. We included observational studies examining male partner HIV status non-disclosure as a risk factor for HIV indicators in pregnant, postpartum women and their infants conducted after the implementation of the Option B+ treatment policy (i.e., lifelong antiretroviral therapy (ART) regardless of clinical disease status) were included. We conducted a meta-analysis for studies without heterogeneity and assessed the certainty of the evidence assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for each outcome. Forty-six full-text articles were screened and only three articles were included. The included studies were cross-sectional and retrospective cohort studies, conducted in Malawi, South Africa, and Uganda, with a total of 5248 participants. Sub-optimal ART adherence was significantly greater among women who did not know their male partner’s HIV status compared to those who knew the partner’s HIV status (2 studies; n= 3263: Odds ratio (OR) 1.85; 95% confidence interval (CI) 1.49–2.29; P <0.01) with no significant heterogeneity (P = 0.72; I2 = 0%). Complete ART adherence was significantly less among women who did not know their male partner’s HIV status compared to those with knowledge of the partner’s HIV status (1 study; n= 465: OR 0.47; 95% CI 0.32 – 0.69). MTCT was not significantly associated with male partner HIV status non-disclosure (1 study; n= 2881: OR 1.35; 95% CI 0.84 – 2.15). The certainty of evidence from all the studies was low for all outcomes. We found that there was limited evidence to fully understand the role a male partner’s HIV status disclosure plays in the PMTCT cascade. The available studies showed that the likelihood of ART non-adherence was increased by not knowing a male partner’s HIV status, therefore, highlighting the importance of knowing a male partner’s HIV status in the PMTCT cascade. We could not explore the other HIV indicators i.e., MTCT and other clinical outcomes due to the limited and non-availability of primary studies. More and appropriately designed studies within the WHO priority countries are needed urgently to inform policies and interventions for improving male partner involvement. These studies should also include a clear definition of male partner involvement which also highlights HIV testing and male partner disclosure.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MSc)--Stellenbosch University, 2022.