Home-based HIV testing and education has potential for increasing HIV testing and access to health information and services among men. However, the extent to which men follow-up to clinic based STI and HIV services is yet to be defined. We aim to understand how a home-based antenatal couple education and HIV testing intervention influences male partner follow-up to clinic-based HIV and STI services including STI treatment, HIV care and treatment, and medical male circumcision.
We conducted a randomized controlled trial of 601 unaccompanied pregnant women attending a first antenatal visit in Kenya from September 2013 to June 2014. Women and their male partners received either the intervention of home-based couple education and HIV-syphilis testing during pregnancy or an invitation letter for standard clinic-based couple HIV testing. Education included identification of STI symptoms and the importance of clinic treatment, in addition HIV treatment for PMTCT and circumcision for HIV-negative men. Male self-reported outcomes were compared between arms at 6 months postpartum.
Among 525 women who completed the study to 6 months postpartum with their infants, we reached 487 men (93%), resulting in 247 and 240 men in the intervention and control arm, respectively. Men of the intervention arm were more likely to report seeking an STI consultation for symptoms [RR=1.59; 95%CI=1.33-1.89]. Syphilis testing at the intervention identified 4 couples requiring treatment and all 4 of these men reported later seeking treatment. Sixty-one men were HIV-infected at study exit, among whom 17 (42%) of 40 intervention men and 5 (24%) of 21 control men were newly diagnosed during the period of the study. Four of 17 men and 3 of 5 men with newly diagnosed HIV in the intervention and control arms, respectively, reported linking to HIV care services [RR=0.69; CI:0.50-0.96]. Few eligible men sought medical circumcision for HIV prevention (4 of 72 intervention and 2 of 88 control).
One-time home-based couple education encouraged male partners to seek clinic STI treatment, however, this was not the case for men with newly diagnosed HIV infection who would likely benefit from additional follow-up to link to care and treatment. Newly diagnosed men identified in home-based testing should be targeted to follow-up linkage to HIV care, which could result in equivalent or better access than clinic-based services alone.