Antenatal Care & Uptake of HIV Testing among Pregnant Women in Sub-Saharan Africa
INTRODUCTION:
Current
guidelines recommend inclusion of HIV testing in routine screening tests for
all pregnant women. For this reason, antenatal care (ANC) represents a vital
component of efforts to prevent mother-to-child transmission (PMTCT) of HIV. To
elucidate the relationship between ANC services and HIV testing among pregnant
women in sub-Saharan Africa, we undertook an analysis of data from four
countries.
METHODS:
Four
countries (Congo, Mozambique, Nigeria and Uganda) were purposively selected to
represent unique geographical regions of sub-Saharan Africa. Using Demographic
and Health Survey datasets, weighted crude and adjusted logistic regression
models were used to explore factors that influenced HIV testing as part of ANC
services. The study was approved by the Institutional Review Board of the
University of Arizona.
RESULTS:
Pooled
results showed that 60.7% of women received HIV testing as part of ANC. Ugandan
women had the highest rate of HIV testing as part of ANC (81.5%) compared with
women in Mozambique (69.4%), Nigeria (54.4%) and Congo (45.4%). Difficulty
reaching a health facility was a barrier in Congo and Mozambique but not
Nigeria or Uganda. HIV testing rates were lower in rural areas, among the
poorest women, the least educated and those with limited knowledge of HIV. In
every country, crude regression analyses showed higher odds of being tested for
HIV if women received their ANC services from a skilled attendant compared with
an unskilled attendant. After adjusting for confounders, women in the total
sample had 1.78 (99% CI: 1.45-2.18) times the odds of having an HIV test as
part of their ANC if they went to a skilled attendant compared with an
unskilled attendant.
CONCLUSIONS:
There
is a need for integration of HIV testing into routine ANC service to increase
opportunities for PMTCT programmes to reach HIV-positive pregnant women.
Attention should be paid to the expansion of outreach services for women in
rural settings, and to the training, supervision and integration of unskilled
attendants into formal maternal and child health programmes. Education of
pregnant women and their communities is needed to increase HIV knowledge and
reduce HIV stigma.
- 1Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- 2Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- 3Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA.
- 4University of Arizona Cancer Center, Tucson, AZ, USA.
- 5Center for Population Health, Arizona Health Sciences Center (AHSC), Center for Population Science and Discovery, College of Medicine, University of Arizona, Tucson, AZ, USA.
- 6Global Health and Implementation Research Initiative, Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
- 7Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA; jehiri@email.arizona.edu.
- J Int AIDS Soc. 2016 Jan 18;19(1):20605. doi: 10.7448/IAS.19.1.20605. eCollection 2016.
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