Abstract
ObjectivesTo identify characteristics associated with obtaining HIV and syphilis screenings of pregnant women attending a first antenatal visit in Lusaka, Zambia.ResultsAmong 18,231 participants from April 2015 to January 2016, 95% obtained HIV screening, 29% obtained syphilis screening, and 4% did not obtain antenatal HIV or syphilis screenings. Divorced/separated women were associated with a moderate decrease in prevalence of obtaining HIV (adjusted prevalence ratio (aPR) 0.88, 95% confidence interval (95% CI) 0.82, 0.95) and syphilis (aPR 0.51, 95% CI 0.27, 0.96) screenings compared to married women. Women with previous pregnancies were associated with a slight decrease in prevalence of obtaining HIV screening (aPR 0.97, 95% CI 0.95, 0.99) compared to women without previous pregnancy. Older women ≥ 35 years were associated with a slight decrease in prevalence of obtaining HIV screening (aPR 0.96, 95% CI 0.92, 0.99) compared to younger women. The statistically significant differences were not of clinical relevance as defined by a proportional difference of 10 percent. Findings of this study show that a vast majority of pregnant women are obtaining HIV screenings but not syphilis screenings during first antenatal visit. Provision of antenatal HIV and syphilis screening at first visit is only weakly related to patient level factors.
Highlights
Despite advances in antenatal recommendations and treatment to prevent mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) and syphilis, congenital infections represent a major global public health burden
Pregnant women who were greater than or equal to 35 years of age (aPR = 0.96; 95% confidence intervals (95% CI) (0.92, 0.99)), divorced/separated (aPR = 0.88; 95% CI (0.82, 0.95)), had a history of syphilis infection, and two or more previous pregnancies (aPR = 0.97; 95% CI (0.95–0.99)) were significantly associated with a decreased prevalence of obtaining an HIV screening
Despite evidence demonstrating the cost-effectiveness and beneficial effects of prioritizing both antenatal HIV and syphilis screenings, previous studies have focused on individual level factors associated with either antenatal HIV or syphilis screenings
Summary
Despite advances in antenatal recommendations and treatment to prevent mother to child transmission (PMTCT) of HIV and syphilis, congenital infections represent a major global public health burden. The most effective method of prevention of mother to child transmission of HIV is to reduce maternal viral load through antiretroviral therapy (ART) during pregnancy and breastfeeding [1]. Without provision of antiretroviral treatment, the rate of vertical transmission of HIV can range from 15 to 45% [2, 3]. Antenatal screenings are a key step in prevention of HIV and syphilis transmission in order to identify seropositive women and start respective treatments [7, 8]. A focus on both HIV and syphilis screening during antenatal care has proven to be feasible, cost-effective, and prevent adverse birth outcomes [9–12].
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