Infection with the HIV and AIDS continue to be leading causes of morbidity and mortality among women and children worldwide . According to 2008 estimates, over 430,000 children were newly infected with HIV, and over 90% of these were through mother-to-child transmission (MTCT) of HIV . MTCT of HIV can occur during pregnancy, labour, delivery, and during breastfeeding. In the absence of any intervention there is a 20% to 45% transmission rate from mother to child, but this risk can drop to 2% in non-breastfeeding populations, and 5% in breastfeeding populations in which specific interventions are carried out . These interventions include: providing lifelong antiretroviral treatment (ART) for all pregnant women with CD4 ≤350 cells/mm3 or advanced clinical disease; providing combination antiretroviral (ARV) prophylaxis with either Zidovudine (AZT) or triple ARV prophylaxis beginning in the second trimester and linked to postpartum prophylaxis; providing prophylaxis to either the mother or the infant during breastfeeding in settings where breastfeeding is the preferred feeding option .
The Global Fund Board recognizes prevention of HIV infection among women, prevention of death among HIV positive women, and preventing babies from being infected with HIV, as crucial priorities . Prevention of mother-to-child transmission (PMTCT) of HIV programs were developed since 1998 to protect women and their babies from infection. At present the World Health Organization (WHO) promotes a comprehensive four-pronged approach for PMTCT. This includes: preventing HIV infection among women of childbearing age; preventing unintended pregnancies among women living with HIV; preventing HIV transmission from a woman living with HIV to her infant; and providing appropriate treatment, care, and support to mothers living with HIV, their children, and their families . These programs are more focused on women and generally omit men. The following pertinent questions therefore stand out: What is the effect of male participation in preventing MTCT of HIV among pregnant women, and how has this participation been documented worldwide?
Knowledge on how male participation has been applied to national PMTCT programs worldwide is limited. The male partner plays an important role in women's reproductive health and improvement of PMTCT outcomes. This role of the male partner in women's risk of acquiring HIV, in the uptake of voluntary counseling and testing (VCT) of HIV and PMTCT programs has been described in many studies [3–6]. Other observational studies indicate that educating men about the importance of family healthcare improves health-seeking behavior for antenatal care and child immunization [7, 8] and also enhances communication and support of the female partner [9, 10]. This evidence suggests that male partner involvement is crucial. The importance of male partner participation is also recognized by the WHO in their 2010 PMTCT Strategic Vision document where it is stated that "male partners play an equally important role in the scale-up of PMTCT services" .
In this era of the HIV/AIDS epidemic, more attention is directed towards incorporating men into reproductive health education interventions . Involving men in PMTCT services could increase the uptake of couple counseling and disclosure of HIV status. This would open doors for the provision of services to HIV-negative couples and discordant couples, as well as preventive care and treatment for HIV-positive couples and their families . Male involvement could enhance partner support for follow-up care for HIV-positive pregnant women and HIV-exposed infants, including ARV adherence, improved adherence to infant feeding methods, and early management of HIV-exposed infants . It could also eliminate harmful consequences faced by women who seek PMTCT services such as stigmatization and gender-based violence. Moreover, male involvement in PMTCT services could address the healthcare needs and responsibilities of men, providing them with positive male norms, and linking them to other healthcare services .
This review seeks to determine the effect of male participation on female uptake of PMTCT services, and assess how male participation in PMTCT has been investigated, described, promoted, and documented worldwide. It will summarize the evidence for and against male participation in PMTCT programs and review the interventions which have been investigated in enhancing male participation in PMTCT activities. It would provide a solid evidence base for advocating increased male participation in PMTCT activities. It would also help formulate recommendations on how to increase male participation in PMTCT activities. From the evidence in the review, we plan to formulate a standardized Scale for the Assessment of Male Participation in PMTCT programs (SAMP-PMTCT). If validated, this scale would serve as a useful tool in assessing the level of male participation in PMTCT activities.
The primary objective of this systematic review is to determine the effect of male participation on female uptake of PMTCT services.
The secondary objectives are: to determine the percentage of men who accept voluntary counseling and testing for HIV, provide moral and financial support to their spouses to adhere to antenatal care (ANC) and PMTCT guidelines; to identify indicators of male participation in PMTCT activities (supportive and non-supportive); to evaluate men's knowledge and approval of PMTCT interventions; to evaluate determinants of male involvement in PMTCT and antenatal care; to evaluate interventions used to enhance male participation in PMTCT; to identify barriers to male participation in PMTCT programs; and to determine potential interventions for improving male involvement in ANC and PMTCT activities.