In rural South Africa, only two-thirds of HIV+ pregnant women seeking antenatal care at community health centers took full advantage of available """"""""prevention of mother-to-child transmission"""""""" (PMTCT) services in 2010 (SADOH). While engagement of male partners has been encouraged as a potential means of increasing PMTCT uptake, men have been reluctant to accompany their wives/partners to antenatal care. Recent studies generally support male involvement in promoting PMTCT, but the nature and impact of that involvement is unclear and untested. It is also clear that factors such as stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be """"""""necessary, but not sufficient"""""""" to accomplish the WHO goal of <5% infant HIV incidence. Additional measures may be needed to increase participation by HIV positive pregnant women in PMTCT. In 2011, Mpumalanga Province had the highest rates of HIV in the country (36.7%) and rates of infant HIV incidence in rural clinics ranged up to 50%. Rates of PMTCT uptake in the Province have been among the lowest in South Africa (69%). This application proposes to expand on a successful PEPFAR- supported, PMTCT couples intervention pilot study conducted in Mpumalanga Province, (""""""""Vikela Umndeni: Protect Your Family"""""""") to include a more representative population of HIV positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention would significantly reduce infant HIV incidence by increasing levels of adherence to ARV/ PMTCT protocols, including breastfeeding and family planning, during the antenatal and post-natal periods. The proposed study will enroll two cohorts of HIV positive pregnant women recruited from 12 randomly assigned Community Health Centers (6 experimental, 6 control): a) Women attending without their male partners (n = 720), followed by b) Women attending with their male partners (n = 720 couples), to determine whether the influence of male participation itself or combined with a behavioral PMTCT intervention can significantly reduce infant HIV infection ante-, peri- and post-natally. It is our intention to significantly increase PMTCT participation from current levels (69%) in Mpumalanga Province to 90-95% through engaging women and couples in a unique, controlled, six session ante- and post-natal risk-reducing/PMTCT promotion intervention addressing the barriers to PMTCT (e.g., stigma, disclosure, intimate partner violence, communication, infant feeding practices, safer conception) that prevent women and men from taking full advantage of the treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the """"""""Vikela Umndeni: Protect Your Family"""""""" program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV+ pregnant women and their infants.

Public Health Relevance

Despite effective treatment protocols and infant feeding guidelines to prevent mother to child HIV transmission (PMTCT), in rural South Africa, only two-thirds of HIV+ pregnant women seeking antenatal care at community health centers took full advantage of available PMTCT services in 2010. Based on a successful pilot study, this application proposes a risk reduction/PMTCT promotion behavioral intervention to increase PMTCT uptake, family planning and male partner participation in the antenatal and postnatal process.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Lee, Sonia S
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University of Miami School of Medicine
Schools of Medicine
Coral Gables
United States
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Peltzer, Karl; Babayigit, Suat; Rodriguez, Violeta J et al. (2018) Effect of a multicomponent behavioural PMTCT cluster randomised controlled trial on HIV stigma reduction among perinatal HIV positive women in Mpumalanga province, South Africa. SAHARA J 15:80-88
Rodriguez, Violeta J; Matseke, Gladys; Cook, Ryan et al. (2018) Infant Development and Pre- and Post-partum Depression in Rural South African HIV-Infected Women. AIDS Behav 22:1766-1774
Jones, Deborah L; Rodriguez, Violeta J; Alcaide, Maria L et al. (2018) The Use of Efavirenz During Pregnancy is Associated with Suicidal Ideation in Postpartum Women in Rural South Africa. AIDS Behav :
Rodriguez, Violeta J; Mandell, Lissa N; Babayigit, Suat et al. (2018) Correlates of Suicidal Ideation During Pregnancy and Postpartum Among Women Living with HIV in Rural South Africa. AIDS Behav :
Peltzer, Karl; Rodriguez, Violeta J; Lee, Tae Kyoung et al. (2018) Prevalence of prenatal and postpartum depression and associated factors among HIV-infected women in public primary care in rural South Africa: a longitudinal study. AIDS Care 30:1372-1379
Peltzer, Karl; Setswe, Geoffrey; Matseke, Gladys et al. (2018) Sexual risk behaviour among HIV-infected women in the first twelve months after delivery in South Africa. J Psychol Afr 28:330-335
Cook, R R; Peltzer, K; Weiss, S M et al. (2018) A Bayesian Analysis of Prenatal Maternal Factors Predicting Nonadherence to Infant HIV Medication in South Africa. AIDS Behav 22:2947-2955
Rodriguez, Violeta J; Cook, Ryan R; Weiss, Stephen M et al. (2017) Psychosocial correlates of patient-provider family planning discussions among HIV-infected pregnant women in South Africa. Open Access J Contracept 8:25-33
Matseke, Motlagabo G; Ruiter, Robert A C; Rodriguez, Violeta J et al. (2017) Factors Associated with Male Partner Involvement in Programs for the Prevention of Mother-to-Child Transmission of HIV in Rural South Africa. Int J Environ Res Public Health 14:
Peltzer, Karl; Weiss, Stephen M; Soni, Manasi et al. (2017) A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa. AIDS Res Ther 14:61

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