Integrating CT for Male Partners of PMTCT Clients, Kinshasa, DRC

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Integrating CT for Male Partners of PMTCT
Clients, Kinshasa, DRC

• Léon MOTINGIA, MD, MCommH
• CDC/GAP-DRC

International HCT Workshop, Lusaka, Zambia
January 20-25, 2008
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Acknowledgement

• UNC/DRC PMTCT-Expansion Team
• Dr Gertrude MUSUAMBA Team leader
• Ms Melanie KAPINGA
• Ms Martine TABALA
• Ms Françoise MAYULU
• Ms Marie-Thérèse MWELA
• Ms Marie Louise BIAYE

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Plan

• Background of HIV Epidemic in DRC
• PMTCT Overview
• Why involve male partners?
• Strategies
• Barriers and Challenges
• Ways of improvement
• Conclusion

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Background of DRC HIV Epidemic

• D.R. CONGO, post-conflict country in Central
  Africa
• Population 60 millions
• Bordered by 9 countries including Zambia in the
  South East
• Generalized HIV epidemic Prevalence 4.1 (PNLS,
  ANC surveillance, 2006)
• HIV data among general population available by
  May 2008 from the first ever DHS done in 2007

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DRC MAP ANC Prevalence Survey 2006, (PNMLS)
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PMTCT Activity Overview (1)

• 2000 PMTCT initiated by private sector,
  BRALIMA/Heineken
• Package included SD NVP to pregnant women at
  onset of labor and to newborns
• 2001 The NACP (PNLS) adopted the PMTCT strategy
  for HIV/AIDS
• 2002 PMTCT pilot project funded by EGPAF in
  collaboration with GTZ, Kinshasa, DRC
• Activities implemented in four maternities

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PMTCT Activity Overview (2)

• The minimum package of interventions included
• Training of maternity staff
• VCT for pregnant women attending the ANC
• Verbal invitation for the male partners
• SD of NVP for pregnant women at the onset of
  labor and to the newborns
• HIV test results were provided after 14 days
• Participation of only 0.1 of male partners

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PMTCT Activity Overview (3)

• 2003 PMTCT-Expansion Project derives from the
  pilot project
• Support from CDC/GAP and implementation by
  University of North Carolina (UNC-CH)
• Currently 32 maternities are involved covering
  25 of pregnancies in Kinshasa
• 2005 Development of national policy documents
  and guidelines
• Definition of the PMTCT Minimum Package of
  Activities including CT of male partners as
  priority

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PMTCT activity challenges

• Low uptake and poor ANC services
• Limited access to rural facilities
• Lack of human capacities
• Stigma and discrimination
• Women inferior and cultural status
• Low participation of male partners

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Increase male partners participation WHY?

• Decision makers within the family unit their
  involvement impacts on the overall well being of
  the family and on the PMTCT strategies
• Safer sex
• Infant feeding decision
• Family planning
• Follow up of HIV mothers and infants
• Couples counseling pre-requisite for the
  provision of comprehensive care to the family
  unit
• Bread winners (transport, etc.)

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Strategies implemented in 2005

• Community mobilization to raise awareness
• Through community-based organizations located
  within the PMTCT site catchments' area
• Sensitization of fiancés couple and married
  couples on reproductive health
• Regular follow up by Community Workers
• Hand delivered letter of invitation for male
  partners of all ANC clients

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Strategies (2)

• Time flexibility to accommodate male partners out
  of working hours (evenings and weekends)
• Additional training of counselors on HIV rapid
  testing
• Routine opt-out intrapartum HCT (labor early
  postpartum) in maternity wards

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Results from the implementation of new strategies
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Barriers and challenges (1)

• Structural constraints Maternities as facilities
  reserved for women health care activities
• Cultural constraints women status
• Reluctance of males to test for HIV and to accept
  results
• Difficulties to access males complaints about
  time, money, etc.

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Barriers and challenges (2)

• Lack of permanent male partners by some pregnant
  women
• Test results not provided the same day in larger
  maternities
• More reservations by women to disclose
• Discordant couples difficult to manage

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Ways to overcome barriers (1)

• Intensive community mobilization targeting
  especially male partners of pregnant women
• Empowerment of pregnant women on HOW, WHEN and
  WHERE to deliver the letter of invitation to
  respective partners
• Reimbursement of transport cost (incentive)
• Priority to accompanied pregnant women in ANC
• Provision of test results same day in larger
  facilities
• Same day couple counseling

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Ways to overcome barriers (2)

• Psychological support to HIV women for
  disclosure
• Active HIV male support groups with different
  themes developed monthly by members
• Additional training for counselors on the
  management of couple counseling (discordant
  couples)

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Conclusion

• Integrating HCT of male partners of PMTCT
  clients is key to achieving Universal Access to
  HIV Prevention, Care and Treatment to the whole
  family unit.

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• Merci beaucoup
• God bless