College of Nursing, University of Illinois Chicago, Chicago, USA.
Kamuzu University of Health Sciences, Blantyre, Malawi.
BMC Pregnancy Childbirth. 2021 Nov 24;21(1):790. doi: 10.1186/s12884-021-04267-6.
HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy.
A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing.
Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication.
HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.
在撒哈拉以南非洲，艾滋病病毒检测是实现零新发感染的关键。尽管大多数妇女在产前护理时接受了检测，但当她们的伴侣未接受检测时，她们仍然面临艾滋病病毒暴露和传播给婴儿的风险。本研究评估了 HIV 增强型以围心为基础的集体产前护理模式（Group ANC+）- 利用互动学习来练习伴侣沟通 - 如何与伴侣在怀孕期间接受 HIV 检测的改善相关。
在马拉维和坦桑尼亚进行的一项随机试点研究发现，与接受个体产前护理的孕妇（n=218）相比，接受 Group ANC+的孕妇有多个积极的结果。本分析增加了两个妊娠晚期结果的未发表结果：与伴侣就三个生殖健康主题（安全性行为、HIV 检测和计划生育）进行沟通，以及自首次产前护理就诊以来伴侣接受 HIV 检测。多变量逻辑回归模型用于评估 ANC 类型对伴侣沟通和伴侣检测的影响。我们还进行了中介分析，以评估伴侣沟通是否介导了护理类型对伴侣 HIV 检测的影响。
Group ANC+中的近 70%的女性报告与伴侣就生殖健康问题进行了沟通，而个体 ANC 中的女性则为 45%。在控制了重要的协变量后，与个体 ANC 中的女性相比，Group ANC 中的女性报告其伴侣接受 HIV 检测的可能性是后者的两倍（OR 1.99；95%CI：1.08，3.66）。Group ANC+模型对伴侣 HIV 检测的积极影响完全由伴侣沟通的增加所介导。
艾滋病毒预防已纳入集体产前护理健康促进，而不会影响服务和标准产前护理主题的覆盖范围，这表明可以使用 Group ANC+将当地高优先级的健康促进需求纳入 ANC。这些发现提供了证据表明，更多的伴侣沟通可以促进健康的生殖行为，包括艾滋病毒预防。需要进一步研究，以了解 Group ANC 如何使妇女与伴侣讨论敏感话题，以及这些沟通如何导致伴侣接受 HIV 检测。
