TY - JOUR
T1 - Antenatal care and uptake of HIV testing among pregnant women in sub-Saharan Africa
T2 - A cross-sectional study
AU - Gunn, Jayleen K.L.
AU - Asaolu, Ibitola O.
AU - Center, Katherine E.
AU - Gibson, Steven J.
AU - Wightman, Patrick
AU - Ezeanolue, Echezona E.
AU - Ehiri, John E.
N1 - Publisher Copyright:
© 2016 Gunn JKL et al; licensee International AIDS Society.
PY - 2016/1/18
Y1 - 2016/1/18
N2 - 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.
AB - 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.
KW - Antenatal care
KW - Global health
KW - Global maternal and child health
KW - HIV testing
KW - Low-income countries
KW - MTCT
KW - Maternal and child health
KW - PMTCT
KW - Prenatal care
KW - Sub-Saharan Africa
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U2 - 10.7448/IAS.19.1.20605
DO - 10.7448/IAS.19.1.20605
M3 - Article
C2 - 26787516
AN - SCOPUS:84960158206
SN - 1758-2652
VL - 19
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 1
M1 - 20605
ER -