“[ Repeat ] testing and counseling is one of the key [ services ] that the government should continue providing”: Participants’ Perceptions on Extended Repeat HIV Testing and Enhanced Counseling (ERHTEC) for Primary HIV Prevention in Pregnant and Lactating Ugandan Women

Abstract Background The ‘Primary HIV Prevention among Pregnant and Lactating Ugandan Women’ (PRIMAL) randomized controlled trail aimed to assess an enhanced counseling strategy linked to extended repeat HIV testing among HIV-negative pregnant and lactating women aged 18-49 years and 410 of their male partners to address the first pillar of the WHO Global Strategy for the Prevention of Mother-to-Child HIV transmission. Methods: PRIMAL Study participants were enrolled from two antenatal care clinics and randomized 1:1 to an intervention or control arm. Both arms received repeat STI and HIV testing at enrollment, labor and delivery, and at 3, 6, 12, 18 and 24 months postpartum. The intervention consisted of enhanced quarterly counseling on HIV risk reduction, couple communication, family planning and nutrition delivered by study counselors. Control participants received repeat standard post-test counseling. Eighteen focus group discussions and 44 key informant interviews were held to evaluate study participants’ and service providers’ perceptions and acceptance of the intervention and understand the effects of the intervention on risk reduction, couple communication, and emotional support from partners. Results: At baseline participants mentioned multiple sexual partners and lack of condom use as the main risks for pregnant and lactating women to acquire HIV. The main reasons for having multiple sexual partners were 1) the cultural practice not to have sex in the late pre-natal and early post-natal period; 2) increased sexual desire during pregnancy; 3) alcohol abuse; 4) poverty; and 5) conflict in couples. Consistent condom use at baseline was limited due to lack of knowledge and low acceptance of condom use in couples. The majority of intervention participants enrolled felt enhanced counselling improved understanding, faithfulness, mutual support and appreciation within their couple. Another benefit mentioned by participants was improvement of couple communication and negotiation, as well as daily decision-making around sexual needs, family planning and condom use. Participants stressed the importance of providing counselling services to all couples. Conclusions: This study shows that repeat postpartum testing and enhanced individual and couple counselling increased condom use, supported risk reduction, and improved support, communication and decision-making about sexual and reproductive health for pregnant and lactating women.