|Antenatal care and uptake of HIV testing among pregnant women in sub-Saharan Africa: a cross-sectional study|
||Jayleen K L Gunn, Ibitola O Asaolu, Katherine E Center, Steven J Gibson, Patrick Wightman, Echezona E Ezeanolue, and John E Ehiri
||Journal of the International AIDS Society, 19:20605; http://dx.doi.org/10.7448/IAS.19.1.20605
Multiple African Countries
||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: 1.452.18) 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.
Keywords: Antenatal care; prenatal care; HIV testing; PMTCT; MTCT; maternal and child health; low-income countries;
sub-Saharan Africa; global health; global maternal and child health.