Does a prenatal consultation dedicated to fathers' health widen men's access to prevention and care? A monocentric interventional research in the Paris metropolitan area

Background and objectivesPrenatal care provides pregnant women with regular opportunities to meet healthcare professionals while not being ill. Nothing similar currently takes place for the second parent. In the PARTAGE project, a prenatal consultation dedicated to future fathers, focused on preserving and improving their own health, has been tested and proven highly acceptable. In this work we analyse the results of this consultation on fathers health and to whom it was most useful. DesignPARTAGE was a monocentric interventional study without control arm. SettingA large public maternity ward in a northeastern suburb of Paris, an area where immigration prevails. ParticipantsAmong 2516 eligible future fathers with effective contact, 1333 were included; fourteen additional sought the consultation directly. InterventionPARTAGE ran from January 2021 to April 2022 (15 months). A physician or a midwife held a medical interview, extended by a physical examination if symptoms were reported, prescribed immediate biological tests, administered vaccination catch-up when necessary, and offered healthcare and social referral depending on participants needs. Outcome measuresIn this work we describe the consultations effects among participant future fathers: HIV lifetime screening rate, HIV prenatal screening rate and test acceptance among delayed participants; Diphtheria-Tetanus-Pertussis-Poliomyelitis (DTaP-IPV) and Measles-Mumps-Rubella (MMR) vaccination coverage and on-site catch-up rates; diagnosis rate for any medical pathology, including reintegration into care of a lost-to-follow-up pathology; medical and social reference rates. ResultsPaternal prenatal consultations resulted in prevention, diagnosis and linkage into care: 37% of participants had never been tested for HIV; 96% had not been tested during or immediately prior to the current pregnancy, of whom 98% accepted HIV screening; 72% were out-of-date for DTaP-IPV or MMR vaccinations, of whom 60% received an on-site catch-up. In addition, 18% had at least one pathology diagnosed or brought back into care; 17% were referred to healthcare professionals and 11% to social workers. Whatever the outcome considered, paternal prenatal consultation benefited socially disadvantaged participants the most: in multivariate analysis, being born in Sub Saharan Africa rather than in France and having no health insurance coverage rather than a complete one were associated with a medical diagnosis (OR 2.67 [1.80-3.98] and OR 2.58 [1.63-4.09], respectively) and with a referral to a healthcare professional (OR 2.67 [1.80-3.98] and OR 3.63 [2.27-5.80], respectively). ConclusionPaternal prenatal consultations led to the diagnosis of undetected illnesses and to the resumption of care for pathologies that had already been diagnosed but were previously lost to follow-up, especially in the most socially disadvantaged future fathers, who were also enabled to meet social workers when necessary. Paternal prenatal consultations were also broadly useful for catching-up on HIV screening and vaccinations in all expectant fathers. Addressing mens health during their partners pregnancy could help reduce gender and social inequalities in health. Clinical Trial numberNCT05085717; Registry: ClinicalTrials.gov, US National Library of Medicine https://classic.clinicaltrials.gov/ct2/show/NCT05085717. Protocol is available as Supplementary file 1. Strengths and limitations of this studyO_ST_ABSStrengthsC_ST_ABS- PARTAGE is, to our knowledge, the first structured health intervention built to address adult mens health, by using the symbolic event of expecting a child; - We demonstrated the feasibility and the positive effects of a paternal prenatal consultation; - In our context, where poverty and immigration prevail, a greater effect was observed among the most disadvantaged men, whose health needs were not met. Limitations- In the absence of a control arm, we showed the effects of such consultation, but not a measurable impact. - Our proactive approach is not directly transferable to routine care. Further research is needed to study how to implement this consultation at a large scale.