Article Text

PDF
Short report
Testing the fathers: carrying out HIV and STI tests on partners of pregnant women
  1. R Dhairyawan,
  2. S Creighton,
  3. L Sivyour,
  4. J Anderson
  1. Department of Sexual Health, Homerton University NHS Trust, London, UK
  1. Correspondence to Dr R Dhairyawan, Department of Sexual Health, Homerton Hospital, Homerton Row, London E9 6SR, UK; rdhairyawan{at}doctors.org.uk

Abstract

Objectives Opt out antenatal HIV testing has significantly reduced mother to child transmission of HIV, but seroconversion during pregnancy from undiagnosed HIV positive male partners remains a risk. The authors report on a pilot initiative for sexual health and HIV screening for male partners of women attending antenatal ultrasound examination at Homerton Hospital, London.

Methods Men attending with their female partners for routine ultrasound examination between 1 August 2010 and 31 January 2011 were offered on-site serology for HIV, syphilis, hepatitis B and hepatitis C and urine testing for Neiserria gonorrhoeae and Chlamydia trachomatis. Results were followed up through the genitourinary medicine service. Referral pathways were established for men with positive results.

Results 1243 male partners of 2400 women attended ultrasound examinations, of whom 430 accepted testing (acceptance rate 35% and coverage rate 18%). Median age was 32 years (range 19–52). 112/430 (26%) male partners were of black ethnicity. 41% had previously had a HIV test. There was no difference in prior HIV testing between whites and non-whites. 16 infections were diagnosed, including two cases of hepatitis C, eight cases of hepatitis B and six cases of C trachomatis. No HIV diagnoses were made.

Conclusions The authors have shown that it is acceptable and feasible to engage heterosexual men for testing in this setting. Of those men who accepted HIV testing, more than half had never been previously tested. 4% of men tested had an infection, which had the potential to affect the outcome of the pregnancy.

Statistics from Altmetric.com

Introduction

Mother to child transmission of HIV has been considerably reduced by opt out testing in pregnant women.1 Women with ongoing risk of HIV seroconversion are advised to have a repeat test in late pregnancy, but identifying them remains a challenge.2

There is a paucity of data around HIV infected heterosexual men in the UK.3 One-third of the estimated 16 200 heterosexual men with HIV infection in the UK remain unaware of their infection. Heterosexual men are over-represented among late presenters.4 Women are twice as likely as men to attend sexual health clinics and primary care and this means that sites where HIV testing is offered need to be carefully selected.5 6

We report on a pilot intervention, targeting male partners of women attending routine antenatal ultrasound examinations at Homerton Hospital, Hackney, where HIV infection prevalence is 8/1000.4

Methods

All male partners of women attending routine antenatal ultrasound examinations between 1 August 2010 and 31 January 2011 were offered screening. Written information was provided within the antenatal scanning department. The tests were promoted by the antenatal and ultrasonography department and further information and testing were provided by a member of the genitourinary medicine (GUM) clinic (health advisor or nurse) who was situated within the antenatal scanning department. Men had the option of seeing the member of staff alone or with their partner. The tests included serology for HIV, syphilis, hepatitis B virus and C virus and urine nucleic acid amplification for Chlamydia trachomatis and Neisseria gonorrhoeae. Results were returned within a week using the GUM clinic's automated telephone system. Patients with positive results were also contacted by health advisors for follow-up.

Data including age, ethnicity, previous HIV tests and results of tests were recorded prospectively. Men were excluded if the ultrasound scan showed fetal abnormality due to potential emotional distress.

This initiative received funding from a Gilead Fellowship award. The male partners were registered as GUM patients and paid for under tariff.

Results

Between 1 August 2010 and 31 January 2011, 2400 pregnant women made 3811 attendances at the antenatal ultrasound unit. HIV testing uptake was 96%. Nineteen (0.8%) were known to be HIV positive and a further 2/2400 (0.1%) women received a new HIV diagnosis.

One thousand two hundred and forty-three partners attended at least one ultrasound appointment of whom 430 accepted testing. The acceptance was 430/1243 (35%) and coverage was 430/2400 (18%) (figure 1). No partners of women with known HIV infection were approached.

Figure 1

Uptake of patients for HIV and STI testing and its outcome. Of the 430 men who accepted testing, 15 had one or more infections diagnosed.

Of the 430 men who accepted testing, 253 (59%) men had no previous HIV tests. The median age of tested men was 32 years (range 19–52). One hundred and twelve (26%) men were of black ethnicity and 65 (15%) were black African.

Fifteen (3.5%) men tested positive for at least one infection. Two men received positive results for viral hepatitis, which they were already aware of, and were not included in the subsequent analysis. Fourteen further infections were diagnosed in 13 men. No HIV diagnoses were made.

Seven men had newly diagnosed hepatitis B infection (two with detectable hepatitis B e-antigen (HBeAg)) and were referred to hepatology. All the pregnant partners were negative for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) and were advised on risk reduction strategies including vaccination.

One man had newly diagnosed hepatitis C infection with detectable hepatitis C virus (HCV) RNA. His partner was HCV immunoglobulin G and RNA negative and was counselled on reducing transmission risk.

Six men tested positive for C trachomatis and were treated. All the female partners were informed of their partners' infection and one tested positive at 31 weeks' gestation. Treatment was verified by our department in five cases. The remaining case was no longer resident in the UK, although we were informed that she had been treated.

Discussion

One thousand two hundred and forty-three men attended the antenatal ultrasound department of whom one-third accepted tests for sexually transmitted infections (STIs). More than half had never previously tested for HIV. Three per cent of men had a treatable infectious disease. No HIV diagnoses were made.

This is the first successful intervention offering testing for HIV and other STIs to the male partners of pregnant women in the UK. Study methodology was robust and data was recorded prospectively. Despite a relatively low uptake at 35%, this is considerably higher than other UK data for example; the TOPAN study in Newham, London saw 21 male partners of 9500 pregnant woman in 1 year.7 Learning from this intervention informed our approach to testing on-site and screening for infections other than HIV. We hope to increase uptake in the future by increasing publicity.

The population size of 430 men was higher than other similar interventions, but did not give sufficient power to determine new HIV diagnoses; the prevalence of undiagnosed HIV in Hackney is approximately 1/4004a and the number of new HIV diagnoses among pregnant women accessing antenatal care at the Homerton is around 1/800. Out of 1200 pregnant women, one woman received a new HIV diagnosis in this time period. Thus the lack of any new HIV diagnoses is consistent with the population size. The sample of men attending antenatal appointments may also differ from those not attending the antenatal appointments, and this may affect their likelihood of testing and thus HIV prevalence.

Barriers to HIV testing in male partners include the impact of a positive result and work commitments.8 9 Data were not collected on men declining testing so we cannot comment on their characteristics or reasons why they declined.

Couple counselling is shown to improve the uptake of HIV testing in men and reduce vertical and horizontal transmission in African settings.9 10 As HIV testing is part of the routine antenatal screen, this may be less feasible in the UK.

We have shown that it is acceptable and feasible to engage heterosexual men for testing in this setting, which would augment services provided within existing health services, most notably primary care. Diagnosing and treating heterosexual men can improve the health of individual men, reduce the risk of onward transmission to mothers and babies and contribute to the wider public health. This may be an intervention that could be applied to other clinics in the UK with a high prevalence of HIV. Future research could look at barriers to testing in this setting and whether point of care HIV tests would be more acceptable.

Key messages

  • Antenatal HIV testing has significantly reduced mother to child transmission of HIV, but seroconversion during pregnancy from undiagnosed HIV positive male partners remains a risk.

  • 430 male partners of pregnant women attending antenatal sonography agreed to testing for HIV and other sexually transmitted infections and 16 new infections were diagnosed.

  • Although no new HIV diagnoses were made, more than half of the men had never tested for HIV before.

  • This an acceptable and feasible setting to engage heterosexual men in areas of high HIV prevalence.

View Abstract

Footnotes

  • Funding Gilead Fellowship Programme award 2010. Keeping Strong: Healthy Fathers Project.

  • Competing interests None.

  • Ethics approval This is a service intervention, not a research study. Hence ethics approval is not needed for the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

References

  1. 1.
  2. 2.
  3. 3.
  4. 4.
  5. 4a.
  6. 5.
  7. 6.
  8. 7.
  9. 8.
  10. 9.
  11. 10.