Factors influencing male involvement in prevention of mother to child transmission of HIV program among Luzira's prisons custodial staff, kampala, uganda.

Abstract

INTRODUCTION: Prevention of mother to child transmission of HIV is a crucial intervention globally in fight against HIV epidemic. Male involvement in PMTCT influences the uptake of the program by their partners. However, male involvement in PMTCT is often a major challenge. In Uganda, PMTCT programs have been characterised by low male involvement, prisons custodial staff being of no exception. There is no data to show factors associated with limited male involvement in PMTCT by custodial staff. The objective of the study was to assess individual, core prison service and health service factors that influence male involvement in PMTCT programs among Luzira’s prisons custodial staff. METHODOLOGY: This was a cross sectional study where both qualitative and quantitative data was collected. The sample consisted of 343 male custodial staffs, married and aged between 18 and 60 years, with at last one child of not more than 10 years of age. Quantitative data was collected by using an interviewer-administered questionnaire. Four focus group discussions and six key informant interviews were conducted. EpiData 2.1 (b) was used to enter quantitative data and stata software version 10/1C was used for analysis using logistic regression as a statistical method. Qualitative data was analysed manually and presented in form of common themes. RESULTS: The major factors that enhanced male involvement in PMTCT were, having tested for HIV (OR 23.9, 95%C1 9.2-62.0), willingness to use condoms once tested HIV positive (OR 24.0, 95%C1 2.8-207.8), Discussing PMTCT with apouse (OR 4.4, 95%C1 19-101), ever having visited a nearby ANC (OR 10.2, 95%C1 3.8-27.0), whether in a discordant relationship where the wife is HIV infected, the couple would separate beds (OR 19.2, 95%C1 3.7-99.9) and using condoms (OR 8.4, 95%C1 2.3-30.7), age OR 0.3 (95%C1 0.1-0.9), for age range31-40 years and OR 0.05 (95%C1 0.01-0.41), for age range 51-60 years vs. 21-30 years, ease of getting and HIV test in prisons (OR 0.3, 95%C1 0.09-0.7) and the increasing rank of respondents (OR 0.08, 95%C1 0.01-0.5). CONCLUSION: Having tested for HIV and a willingness to use condoms appear to be major indicators of male involvement in PMTCT programs at Luzira prison. Other factors including access to ANC, age, prior discussion with spouse and (for discordant couples) other prevention measures being in place also seem to be associated with such male involvement. It was noted that higher ranked officers were unlikely to be involved in PMTCT services. RECOMMENDATIONS: Prison services need to scale up HIV testing in prisons and to increase accessibility of HIV testing services. These services could be used as an important entry point for promoting male involvement in PMTCT. There is a need for prisons services to develop and tailor age specific, rank specific and education specific advocacy and counselling programs promoting the usefulness of male involvement in PMTCT programs.