Engaging Partners in Childbirth for Prevention of Mother-To-Child Transmission of HIV (EPiC-pMTCT): preliminary work for a randomised controlled trial

让伴侣参与分娩以预防艾滋病毒母婴传播 (EPiC-pMTCT)：随机对照试验的初步工作

• 批准号: MR/M002543/1
• 负责人: Leroy Edozien
• 金额: $ 10.79万
• 依托单位: University of Manchester
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2014
• 资助国家: 英国
• 起止时间: 2014 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FM002543%2F1
• 关键词: Engaging; Partners; Childbirth; Prevention; Mother

HIV is a major public health problem, and a major route of transmission is Mother-To-Child Transmission (MTCT) which accounts for about 10% of the national HIV burden in African countries. Prevention of this mode of transmission (pMTCT) is a key element in global HIV prevention and the World Health Organisation has recommended that pMTCT of HIV infection should be prioritized in sub-Saharan Africa.Evidence-based interventions to reduce MTCT are available in many maternity units in Africa, but their uptake is poor. The barriers to uptake are closely linked with the role of the male partners in perinatal care of the woman. It is known that men are the primary decision makers in many African countries where pMTCT is offered. Studies show that women are more likely to (a) undergo HIV testing, (b) disclose their HIV status to their husband, (c) adhere to treatment during pregnancy (d) deliver in a pMTCT facility and, (e) comply with infant feeding recommendations if their partners are engaged in the pMTCT programme. While male participation has a potentially positive impact on the uptake of pMTCT interventions, initiatives to prevent mother-to-child HIV transmission in sub-Saharan Africa have focused overwhelmingly on women, to the unintended exclusion of their male partners. The actual impact of male involvement is unknown, as there is a lack of quantitative data on the benefits and effectiveness of male partner engagement. A recent Cochrane meta-analysis found only one eligible study that assessed the effectiveness of male involvement in improving women's uptake of pMTCT services, and that study only focused on one part of the perinatal pMTCT cascade. While male involvement holds promise for improving uptake of pMTCT interventions, further rigorous evaluation and implementation research is needed.Efforts in this direction must, however, begin by addressing conceptual and methodological issues in the study and implementation of male partner involvement in pMTCT. A uniform definition of male participation in pMTCT programmes does not exist, and there are no standardized measures or reliable indicators of male involvement. Also needed is a reconceptualisation of the role of men in pMTCT. It has been argued that to maximize the health outcomes of pMTCT programs, men should not be seen as simply "facilitating factors" that enable women to access health-care services, but be recognized as a constituent part of reproductive health policy and practice. Also, efforts to include male partners in HIV prevention for women have focused primarily on engaging men to support their female partners in adopting a prevention strategy, without also offering broader consideration for men's own health needs or of a social agenda aimed at promoting greater sex equality.In a future study we propose to undertake a randomised controlled trial to assess a multi-component family-centred intervention. The hypothesis for the trial is that implementation of the intervention would result in improved uptake of pMTCT programmes in the intervention arm compared with the control arm. Before embarking on the trial, we propose to undertake development work (the current study) that will devise a programme of engagement of partners (i.e. the multi-component EPiC-pMTCT intervention) based on evidence in the literature and qualitative data from this study, and also assess the feasibility of conducting the cluster randomised controlled trial. The results from this development work will also inform the selection of centres that will participate in the proposed trial if it is deemed feasible.The outputs from this research will comprise a synthesis of the evidence on barriers to male engagement in pMTCT, an analysis of the perspectives of men, women, health professionals and policy makers on male engagement, an intervention package, and a report on the feasibility of collecting the data required for the trial.

艾滋病毒是一个主要的公共卫生问题，主要的传播途径是母婴传播，约占非洲国家艾滋病毒负担的10%。预防母婴传播是全球预防艾滋病毒的一个关键因素，世界卫生组织建议，应优先考虑撒哈拉以南非洲的母婴传播艾滋病毒感染，非洲许多产科单位都有减少母婴传播的循证干预措施，但这些措施的采用率很低。吸收障碍与男性伴侣在妇女围产期护理中的作用密切相关。众所周知，在提供预防母婴传播服务的许多非洲国家，男子是主要的决策者。研究表明，妇女更有可能（a）接受艾滋病毒检测，（B）向丈夫透露自己的艾滋病毒状况，（c）坚持在怀孕期间接受治疗，（d）在预防母婴传播设施分娩，以及（e）如果其伴侣参与预防母婴传播方案，则遵守婴儿喂养建议。虽然男性的参与对预防母婴传播干预措施的采用具有潜在的积极影响，但在撒哈拉以南非洲，预防母婴传播艾滋病毒的举措绝大多数侧重于妇女，无意中将其男性伴侣排除在外。男性参与的实际影响尚不清楚，因为缺乏关于男性伙伴参与的益处和效力的量化数据。最近的一项科克伦荟萃分析发现，只有一项合格的研究评估了男性参与改善妇女接受pMTCT服务的有效性，该研究仅关注围产期pMTCT级联的一部分。虽然男性的参与有望提高预防母婴传播干预措施的接受率，但还需要进一步进行严格的评价和实施研究，但这方面的努力必须开始时解决研究和实施男性伴侣参与预防母婴传播的概念和方法问题。对男性参与预防母婴传播方案没有统一的定义，也没有衡量男性参与情况的标准或可靠指标。还需要重新认识男子在预防母婴传播中的作用。有人认为，为了最大限度地扩大预防母婴传播方案的健康成果，不应将男子仅仅视为使妇女能够获得保健服务的“促进因素”，而应将其视为生殖健康政策和做法的一个组成部分。此外，包括男性伴侣在艾滋病毒预防妇女的努力主要集中在从事男性支持他们的女性伴侣通过预防战略，也没有提供更广泛的考虑男性自己的健康需求或社会议程，旨在促进更大的性别平等。在未来的研究中，我们建议进行一项随机对照试验，以评估多组分的家庭为中心的干预措施。该试验的假设是，与对照组相比，实施干预措施将导致干预组对pMTCT计划的接受率提高。我们建议进行开发工作，（目前的研究），将制定一项伙伴参与方案，（即多组分EPiC-pMTCT干预），并评估进行群集随机对照试验的可行性。这项开发工作的结果也将为选择参与拟议试验的中心提供信息，如果认为可行的话。这项研究的成果将包括对男性参与pMTCT障碍的证据的综合，对男性、女性、卫生专业人员和政策制定者对男性参与的观点的分析，干预方案，以及关于收集试验所需数据的可行性报告。