Effect Of Letter Of Invitation Through Mother Support Group Counselling To Enhance Male Involvement In Prevention Of Mother To Child Transmission Of HIV Program In Bale Zone, South East Ethiopia: Quasi Experimental Study

.

Background:

Prevention of mother to child transmission of HIV program requires great male participation. Currently, it is well known that male involvement (MI) in PMTCT as critical steps in reducing pediatric HIV infection. Male partner's involvement in maternal health service is reported to be associated with increased uptake of antenatal care, improve facility-based delivery, contraception use and decreased mother-to-child transmission of HIV. Some evidences also showed that when couples receive counseling together, there is a better use of infant feeding methods, have a higher acceptance of HIV testing, promotes couple communication, mutual disclosure, mutual decision making on issues to do with safer sex. Similarly, a study from Kenya reported that male partner's involvement in antenatal care is associated with low risk of HIV infection in infants of HIV infected women, greater HIV free survival and reduce infant mortality by up to 40 % . However, in the majority of SSA male involvement is still small particularly partner testing rate is low. In Ethiopia, the ministry of health policy advocates for HIV counseling and testing of male partners in ANC setting. In spite of this policy, the proportion of male partners of ANC attendees testing for HIV in these setting is low. For instance, in 2012, the rates of MI in PMTCT remain low in Ethiopia, only 20% of antenatal women being accompanied by their partners despite the government is trying to make it 50%.

Studies showed that several barriers to male involvement (MI) in ANC and PMTCT of HIV service. The identified barriers were individual, socio-economic, cultural and health-system-related barrier. To respond for the factors, Ethiopia has made major efforts through the scale up of PMTCT program. Yet, MI in the program still remains a major obstacle to a national response to achieving elimination of mother to child transmission(eMTCT) of HIV for the country. Increasing MI in ANC and PMTCT services requires innovation and evidence-based strategies to overcome barriers to participation towards the eMTCT agenda. Many countries have used different strategies to promote participation of men in ANC but few have been evaluated to provide important lessons to support wider implementation. In Ethiopia there is a gap in strategies to enhance male involvement in PMTCT program, which has not been fully addressed in the country. Hence, this study is proposed to evaluate the effect of a formal letter of invitation delivered through mother support group to the pregnant mother attending her first antenatal contact without her partner to promote male partners' attendance and HIV counselling and testing at antenatal care with his wife during a follow-up period as per the new WHO ANC model recommendation schedule.

Hypotheses / Research Question(s) The investigator hypothesize that letter of invitation through mother support group counseling will or will not promote or increase male participation in PMTCT/ANC program as compared to a standard care (oral invitation)