P27. Engagement of community leaders in improving male involvement in prevention of mother-to-child transmission of HIV services in Dar es Salaam, Tanzania

Goodluck Lyatuu1, Sarah Mdingi1, Happiness Koda1, Yusuph Chende1, Martha Tsere1, Helen Siril1, Irene Andrew1, Aisa Mhalu1, Tabu Mganga2, Happy Magatti3, Noela Chacha4, Helga Naburi5, Eric Aris1, Aisa Muya1, Gunnel Biberfeld6, Charles Kilewo5, Anna Mia Ekström6
Affiliates: 1Management and Development for Health (MDH), Dar es Salaam, Tanzania 2Kinondoni Municipal Council (KMC), Dar es Salaam, Tanzania 3Ilala Municipal Council (IMC), Dar es Salaam, Tanzania 4Temeke Municipal Council (TMC), Dar es Salaam, Tanzania 5Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania 6Karolinska Institutet, Stockholm, Sweden

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Background
Male involvement in prevention of mother-to-child transmission of HIV (PMTCT) services has been known to improve uptake, retention and outcomes of PMTCT services. Couple HIV counseling and testing (HCT) at antenatal clinic (ANC) is an important entry point to male involvement but remains very low in many PMTCT programs. In 2014, Dar es Salaam, Tanzania had a regional average couple HCT rate of 13%.

Methods
From April 2015, an intervention was designed and implemented to increase couple HCT in 6 purposively selected pilot health facilities in Dar es Salaam. The intervention was built on the experience of one best practice health facility that had succeeded to increase couple HCT from 1% to 92% over a period of four years. Main strategies behind this success were: (1) Sensitizing and garnering commitment from health care providers (HCPs) and managers in provision of couple friendly services; (2) Forging partnerships between clinical and community leaders in implementing male involvement initiatives across facility and community levels; and (3) Engaging community leader champions in integrating and leading initiatives to promote male involvement in PMTCT, in routine community meetings and activities. Following the success of the best practice site, the strategies were studied, documented, benchmarked and used as a basis for scaling up the best practice to 6 other pilot health facilities. A baseline sensitization meeting was conducted and a study tour was done to the best practice site to provide HCPs and community leaders from the 6 scale-up sites, a practical learning experience. Thereafter site-specific action plans were developed and implemented, adapting the best practice interventions to the specific needs and situation in each facility.

Results
At baseline, in quarter January-March 2015, a total of 4,429 new pregnant women who registered for ANC services were tested for HIV in 6 facilities targeted for male involvement scale up. Of these women, 528 (12%) tested for HIV together with their partners (i.e. couple HCT). In comparison, during the same period, 5,085 (18%) pregnant women tested for HIV as couples in 214 other control sites. Twelve months after implementation of the male involvement scale up intervention, in quarter January- March 2016, couple HCT in the 6 scale-up HFs almost tripled whereby 1,436 (34%) out of 4,236 new pregnant women tested for HIV with their partners. In comparison, 5,768 (20%) pregnant women tested for HIV with their partners in the control sites. Varying performance was observed across the scale-up sites ranging from 7% to 95%, with the 2 sites located in the same district as the best practice site performing considerably higher (95% and 75%) than the other 4 sites (7%-19%). The observed variation was in part contributed by the varying degree of engagement, commitment and participation of community leaders and health facility management.

Conclusion
Effective engagement of community leaders and functional partnerships between health care providers and community leaders can achieve rapid improvement in couple HIV counseling and testing and male involvement in PMTCT services.