College of Medicine and Public Health, Flinders University, Adelaide, Australia.
School of Nursing and Midwifery, Deakin University and Western Health Partnership, Burwood, Australia.
PLoS One. 2020 Oct 15;15(10):e0240087. doi: 10.1371/journal.pone.0240087. eCollection 2020.
Childhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV.
A realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome.
Three CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make 'male friendly' adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV.
The CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a 'male friendly space' and where there are high levels of community education programs around MTCT.
儿童人类免疫缺陷病毒（HIV）感染几乎完全是通过母婴传播（MTCT）在妊娠、分娩期间或通过母乳喂养发生的。最近的研究表明，男性参与产前保健（ANC）和 HIV 检测，包括夫妇自愿咨询和检测（CVCT），增加了妇女在怀孕期间坚持预防建议并遵守 HIV 治疗的可能性；从而降低了 HIV 的 MTCT 率。这项现实主义审查调查了男性参与 ANC 如何、为何、何时以及对谁最有效，以提供有关如何将 ANC 中的男性参与用于预防母婴传播（PMTCT）HIV 的背景建议。
对现有证据进行了现实主义审查。现实主义审查旨在解释干预措施在特定背景下如何以及为何有效或无效。这是通过现实主义综合的五个阶段完成的；引出计划理论、搜索策略、研究选择标准、数据提取和数据分析和综合。研究结果以阐述在特定背景下发挥作用以产生结果的机制的 CMO 配置呈现。
制定了三个 CMO 配置。这些描述了：1）处于一夫一妻制关系中的夫妇具有更高的信任度、承诺和安全感，从而增加了共同参与 PMTCT 计划的可能性；2） ANC 空间进行“男性友好”调整，促进了 PMTCT 中男性参与的正常化，并更加欢迎，从而增加了男性伴侣参与 ANC 的意愿；3）具有更高健康素养的夫妇和社区鼓励增加知情决策、所有权和责任感，从而增加参与 HIV 的 PMTCT 的意愿。
本审查制定的 CMO 为如何改善 ANC 服务以增加 MI 并帮助降低 HIV 的 MTCT 提供了背景建议。我们提出，在夫妻双方都是一夫一妻制和信任的情况下，ANC 空间积极促进成为“男性友好空间”，并且有高水平的社区教育项目围绕 MTCT 进行的情况下，ANC 中的 MI 效果最佳。
