Transcript Impact of a male centered rapid results initiative approach on PMTCT services in FACES supported MOH facilities in Nyanza Province Akama E.1,2, Mburu.

Impact of a male centered rapid results initiative
approach on PMTCT services in FACES
supported MOH facilities in Nyanza Province
Akama E.1,2, Mburu M.1,2, Mutegi E1,2, Nyanaro G.1,2,
Otieno JP.1,2 Ndolo S.1,2, Ojwang’ L.6 Lewis-Kulzer J.2,3,
Abuogi L.2, 4, Oyaro P.1,2, Cohen, C.R.1,3, Bukusi, E.A. 1,2,
Onono M.1,2
1.
2.
3.
4.
Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
Family AIDS Care and Education Services, Kisumu, Kenya
University of California San Francisco, San Francisco, CA, USA
University of Colorado School of Medicine2, Department of
Pediatrics4,, Aurora, Colorado
5. Ministry of Health (MOH), Kenya
BACKGROUND
Studies have shown that male partner
participation in antenatal care (ANC) increases
uptake of Prevention of Mother-to-ChildTransmission (PMTCT) interventions by their
female partners
OBJECTIVES
To evaluate the impact of a male-centered
Rapid Results Initiative (RRI) aimed at:
 increasing male involvement
 skilled delivery
 time to and linkage to antiretroviral
services
Setting
• FACES is a PEPFAR-funded comprehensive
HIV prevention, care and treatment program
based in Migori, Homa bay, Kisumu Counties
• The RRI was implemented at 116 FACES
supported Kenyan Ministry of Health (MOH)
clinics in three counties
RRI Strategies encompassed
– abbreviated male medical checkup
– calling and visiting men who did not
accompany their partners to ANC
– text and call reminders to pregnant women to
bring their partners to ANC
We compared aggregated site level
cohort data of women attending first ANC
• Jan to March
2013
• 7236 women
Baseline
During
• April to June
• 7426 women
• July to
September
2013
• 7125 women
Post RRI
Methodology
Analysis
– We used pre-post cohort analysis using STATA
version 12
– We compared the figures obtained during the
baseline, RRI and post-RRI surveys to assess
whether there were significant changes
during the periods with the baseline period
as the reference point
Methodology:
• Analysis
– Temporal changes in indicators were
considered significant at a p-value <0.05
– Risk ratios (95% Confidence Intervals) and
risk difference were reported for each
indicator
RESULTS
Indicator
Baseline
JanMar2013
Indicator
N(%)
RRI Period
Apr-Jun2013
Post-RRI Period
Jul-Sep2013
N(%)
Risk Ratio
(95% CI)
N(%)
Risk Ratio
(95% CI)
Male
Involvement
7.4%
54.2%
7.3(6.7-8.0)
43.4%
5.9(5.46.4)
Skilled
Delivery (all)
48.1%
62.5%
1.3(1.3-1.3)
74.5%
1.6(1.51.6)
Skilled
40%
Delivery
(HIV+)
HIV+ Linked to 58.6%
Care
49.9%
1.3(1.2-1.4)
65%
1.6(1.51.8)
85.9%
1.5(1.4-1.5)
97.3%
1.7(1.61.7)
Median Time
To HAART
14(0-28)
Days
p-value
<0.001
7(0-20) p-value
Days
<0.001
29(6-56)
Days
A male-centered, scalable RRI can drastically
increase men’s engagement in ANC and improve
their female partner’s utilization of PMTCT services
and health facility skilled delivery
This approach has the potential to reduce both
maternal and perinatal morbidity and mortality in
HIV affected regions
ACKNOWLEDGEMENTS
• Kenyan Ministries of Health (MOH)
• Family AIDS Care and Education Services (FACES)
• Kenya Medical Research Institute (KEMRI)
• University of California San Francisco (UCSF)
• U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
• U.S. Centers for Disease Control and Prevention (CDC)
• The women, men and children in the communities served
The findings and conclusions in this presentation are those of the author(s) and do
not necessarily represent the official position of U.S. Centers for Disease
Control and Prevention/the and the Government of Kenya
This research has been supported by the President’s Emergency Plan for AIDS
Relief (PEPFAR) through the U.S Centers for Disease Control under the terms
of Cooperative Agreement # PS001913