“The co-authors of pregnancy”: leveraging men’s sense of responsibility and other factors for male involvement in antenatal services in Kinshasa, DRC

Background: Despite efforts to improve male involvement (MI), few male partners typically attend antenatal care (ANC). MI in ANC and interventions to prevent mother-to-child HIV transmission have been demonstrated to be beneficial for the HIV-positive mother and her child. This study aimed to explore factors influencing partner attendance and highlight interventions with potential to improve MI within a Congolese context. Methods: This was an exploratory, qualitative study conducted in two urban and two semi-urban catchment areas of Kinshasa, DRC in June–September 2016. Two women-only and two men-only focus group discussions (FGDs) were held; participants were recruited from ANC clinics and surrounding communities. Key informants purposively selected from health facility leadership and central government were also interviewed. Guide topics included MI barriers and facilitators, experiences with couples’ ANC attendance and perceptions of MI interventions and how to improve them. Data from FGDs and interviews were analyzed to determine three interventions that best addressed the identified MI facilitators and barriers. These interventions were explored further through dialogues held with representatives from community organizations. Results: This study included 17 female and 18 male FGD participants, 3 key informants and 21 community dialogue participants. Receipt of clinic staff advice was the most commonly-reported factor facilitating male attendance. No time off work was the most commonly-reported barrier. Only men identified responsibility, referring to themselves as “authors of the pregnancy,” and wanting to be tested for HIV as facilitators. The most promising interventions perceived by FGD and interview participants were male partner invitation letters, couple- and male-friendly improvements to ANC, and expert peer-to-peer outreach. Community dialogue participants provided further detail on these approaches, such as invitation letter content and counseling messages targeting men attending ANC. Conclusions: Common themes regarding male involvement in ANC that emerged from this study included men’s need to understand how the pregnancy is progressing and how best to care for their female partners and unborn children, and ANC settings that were misaligned to the needs of men and couples. Interventions at the individual, facility and community levels were discussed that could result in improvements to male attendance at pregnancyrelated services

Changing spatial patterns and increasing rurality of HIV prevalence in the Democratic Republic of the Congo between 2007 and 2013

The Democratic Republic of the Congo (DRC) has one of the lowest HIV prevalence in sub-Saharan Africa, estimated at 1.1% [0.9-1.3] of adults aged 15-49 in 2013 (UNAIDS). Within the 2 million km2 country, however, there exists spatial variation in HIV prevalence, with the highest HIV prevalence observed in the large cities of Kinshasa and Lubumbashi. Globally, HIV is an increasingly rural disease, diffusing outwards from urban centers of high HIV prevalence to places where HIV was previously absent or present at very low levels. Utilizing data collected during Demographic and Health Surveillance (DHS) in 2007 and 2013 in the DRC, we sought to update the map of HIV prevalence in the DRC as well as to explore whether HIV in the DRC is an increasingly rural disease or remains confined to urban areas. Bayesian kriging and regression indicate that HIV prevalence in rural areas of the DRC is higher in 2013 than in 2007 and that increased distance to an urban area is no longer protective against HIV as it was in 2007. These findings suggest that HIV education, testing and prevention efforts need to diffuse from urban to rural areas just as HIV is doing

Estimating the burden of rubella virus infection and congenital rubella syndrome through a rubella immunity assessment among pregnant women in the Democratic Republic of the Congo: Potential impact on vaccination policy.

BACKGROUND: Rubella-containing vaccines (RCV) are not yet part of the Democratic Republic of the Congo's (DRC) vaccination program; however RCV introduction is planned before 2020. Because documentation of DRC's historical burden of rubella virus infection and congenital rubella syndrome (CRS) has been minimal, estimates of the burden of rubella virus infection and of CRS would help inform the country's strategy for RCV introduction. METHODS: A rubella antibody seroprevalence assessment was conducted using serum collected during 2008-2009 from 1605 pregnant women aged 15-46years attending 7 antenatal care sites in 3 of DRC's provinces. Estimates of age- and site-specific rubella antibody seroprevalence, population, and fertility rates were used in catalytic models to estimate the incidence of CRS per 100,000 live births and the number of CRS cases born in 2013 in DRC. RESULTS: Overall 84% (95% CI 82, 86) of the women tested were estimated to be rubella antibody seropositive. The association between age and estimated antibody seroprevalence, adjusting for study site, was not significant (p=0.10). Differences in overall estimated seroprevalence by study site were observed indicating variation by geographical area (p⩽0.03 for all). Estimated seroprevalence was similar for women declaring residence in urban (84%) versus rural (83%) settings (p=0.67). In 2013 for DRC nationally, the estimated incidence of CRS was 69/100,000 live births (95% CI 0, 186), corresponding to 2886 infants (95% CI 342, 6395) born with CRS. CONCLUSIONS: In the 3 provinces, rubella virus transmission is endemic, and most viral exposure and seroconversion occurs before age 15years. However, approximately 10-20% of the women were susceptible to rubella virus infection and thus at risk for having an infant with CRS. This analysis can guide plans for introduction of RCV in DRC. Per World Health Organization recommendations, introduction of RCV should be accompanied by a campaign targeting all children 9months to 14years of age as well as vaccination of women of child bearing age through routine services

Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015.

Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged 50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection

Addressing Early Retention in Antenatal Care Among HIV-Positive Women Through a Simple Intervention in Kinshasa, DRC: The Elombe Champion Standard Operating Procedure

This cluster-randomized study aimed to assess the Elombe ( Champion ) standard operating procedure (SOP), implemented by providers and Mentor Mothers, on HIV-positive pregnant women\u27s retention between first and second antenatal visits. Sixteen facilities in Kinshasa were randomly assigned to intervention (SOP) or comparison (no SOP). Effect of the SOP was estimated using relative risk. Women in comparison facilities were more likely to miss second visits (RR 2.5, 95% CI 1.05-5.98) than women in intervention facilities (30.0%, n = 27 vs. 12.0%, n = 9, p \u3c 0.002). Findings demonstrate that a simple intervention can reduce critical early loss to care in PMTCT programs providing universal, lifelong treatment

Evaluation of the practicability and virological performance of finger-stick whole-blood HIV self-testing in French-speaking sub-Saharan Africa

<div><p>Background</p><p>Opportunities for HIV testing could be enhanced by offering HIV self-testing (HIVST) in populations that fear stigma and discrimination when accessing conventional HIV counselling and testing in health care facilities. Field experience with HIVST has not yet been reported in French-speaking African countries.</p><p>Methods</p><p>The practicability of HIVST was assessed using the prototype the Exacto^® Test HIV (Biosynex, Strasbourg, France) self-test in 322 adults living in Kisangani and Bunia, Democratic Republic of the Congo, according to World Health Organization’s recommendations. Simplified and easy-to-read leaflet was translated in French, Lingala and Swahili.</p><p>Results</p><p>Forty-nine percent of participants read the instructions for use in French, while 17.1% and 33.9% read the instructions in Lingala and Swahili, respectively. The instructions for use were correctly understood in 79.5% of cases. The majority (98.4%) correctly performed the HIV self-test; however, 20.8% asked for oral assistance. Most of the participants (95.3%) found that performing the self-test was easy, while 4.7% found it difficult. Overall, the results were correctly interpreted in 90.2% of cases. Among the positive, negative, and invalid self-tests, misinterpretation occurred in 6.5%, 11.2%, and 16.0% of cases, respectively (P<0.0001). The Cohen’s κ coefficient was 0.84. The main obstacle for HIVST was educational level, with execution and interpretation difficulties occurring among poorly educated people. The Exacto^® Test HIV self-test showed 100.0% (95% CI; 98.8–100.0) sensitivity and 99.2% (95% CI; 97.5–99.8) specificity.</p><p>Conclusions</p><p>Our field observations demonstrate: (i) the need to adapt the instructions for use to the Congolese general public, including adding educational pictograms as well as instructions for use in the local vernacular language(s); (ii) frequent difficulties understanding the instructions for use in addition to frequent misinterpretation of test results; and (iii) the generally good practicability of the HIV self-test despite some limitations. Supervised use of HIVST is recommended among poorly-educated people.</p></div

Analytical results of the manipulation observation concerning the ability of the 322 study participants to correctly use each step of the Exacto^® Test HIV (Biosynex) manipulation autonomously or with oral assistance.

<p>Analytical results of the manipulation observation concerning the ability of the 322 study participants to correctly use each step of the Exacto^® Test HIV (Biosynex) manipulation autonomously or with oral assistance.</p

Instructions for use of the Exacto^® Test HIV (Biosynex) self-test designed for the Congolese general public using typical pictures representative of the principal steps of the manufacturer’s instructions with explanations written in Swahili, the most frequently used vernacular language of the former Province Orientale of the Democratic Republic of the Congo.

<p>Other available languages were French and Lingala. <b>A. Identification of the components: Ⓐ</b> Bag, <b>Ⓑ</b> Test cassette, <b>Ⓒ</b> Diluent vial, <b>Ⓓ</b> Disinfectant wipe, <b>Ⓔ</b> Compression swab, <b>Ⓕ</b> Lancet, <b>Ⓖ</b> Sampler stick, <b>Ⓗ</b> Dressing. <b>B. Performing the self-test</b>: 1. Wash your hands; 2. Take the self-test out of the bag <b>Ⓐ</b>; 3. Open the diluent vial <b>Ⓒ</b>; 4. Disinfect the chosen fingertip with the disinfectant wipe <b>Ⓓ</b>; 5. Wipe off residual alcohol with the compression swab <b>Ⓔ</b>; 6. Apply the lancet <b>Ⓕ</b> on the chosen fingertip and push the other tip to sting; 7. Press gently on the fingertip to obtain a drop of blood; 8. Place in contact the drop of blood with the sampler stick <b>Ⓖ</b> until the inverted cup becomes full; 9. Check that the sampler tip <b>Ⓖ</b> is filled with blood; 10. Place the blood into the SQUARE well BLOOD of the test cassette <b>Ⓑ</b>; 11. Shed two drops of diluent in the ROUND well DILUENT of the test cassette <b>Ⓑ</b>; 12. Wait exactly 10 minutes before reading the result.</p

Demographic characteristics and medical history of the 322 study participants.

<p>Demographic characteristics and medical history of the 322 study participants.</p