Efficacy of enhanced HIV counseling for risk reduction during pregnancy and in the postpartum period: a randomized controlled trial.

Suzanne Maman,Allison K Groves,Heathe Luz Mcnaughton-Reyes,Prashini Moodley,Dhayendre Moodley,Ashraf Kagee,James G Beeson

doi:10.1371/journal.pone.0097092

Abstract

IntroductionPregnancy and the postpartum period present important intervention opportunities. Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants.MethodsPregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment (n = 733) and control arms (n = 747). Treatment arm participants received enhanced HIV pre- and post-test counseling, legal support and access to support groups at baseline, which occurred at the first antenatal visit, and then six and ten weeks postpartum. Control arm participants received standard HIV testing and counseling (HTC) and two postpartum attention control sessions. Outcomes were incidence of sexually transmitted infection (STI) by 14 weeks postpartum and past 30-day inconsistent condom use at 14 weeks and 9 months postpartum.ResultsThere were no intervention effects on incident STIs for either HIV-negative (adjusted risk ratio (aRR) 1.01, 95% CI 0.71–1.44) or HIV-positive participants (aRR 0.86, 95% CI 0.61–1.23). The intervention was associated with a 28% decrease in risk of past 30-day inconsistent condom use at nine-months among HIV-negative women (aRR 0.72,95% CI 0.59–0.88), but did not affect inconsistent condom use among HIV-positive women (aRR1.08; 95% CI 0.67–1.75).DiscussionAn enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women. Results underscore the importance of the counseling that accompanies HIV HTC. More work is needed to understand how to promote and sustain risk reduction among HIV-positive women.Trial RegistrationClinicalTrials.gov NCT01683461

Highlights

Pregnancy and the postpartum period present important intervention opportunities
HIV counseling and testing (HCT) protocols were designed for clients seeking voluntary HIV counseling and testing services, and as such they were not tailored to be used in other health care settings such as antenatal care to address the decisions that women have to make in the context of pregnancy
Given that many women are presented with the opportunity for HCT for the first time in antenatal care there is a need to tailor HCT programs for antenatal care to capitalize on this prevention opportunity

Summary

Introduction

Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants. There is evidence that women are more motivated to address health issues during pregnancy and the postpartum period and it may be easier to change behaviors during such important transitional periods [6]. Counseling can leverage the motivation women have during pregnancy and in the postpartum period to change behaviors that may negatively affect their health and the health of their infants. The aim of the current study was to evaluate the effectiveness of an enhanced HIV testing and counseling intervention for HIV-positive and HIV-negative pregnant women on consistent condom use and incident STIs during pregnancy and the postpartum period

Objectives

Methods

Results

Conclusion