Abstract
IntroductionPrevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV. Identification and support for HIV negative pregnant women and their partners, particularly serodiscordant couples, are critical. A mixed method study done in Southern Mozambique estimated HIV incidence during pregnancy, associated risk factors and factors influencing partner's HIV testing.MethodsBetween April 2008 and November 2011, a prospective cohort of 1230 HIV negative pregnant women was followed during pregnancy. A structured questionnaire, HIV testing, and collection of dried blood spots were done at 2–3 scheduled visits. HIV incidence rates were calculated by repeat HIV testing and risk factors assessed by Poisson regression. A qualitative study including 37 individual interviews with men, women, and nurses and 11 focus group discussions (n = 94) with men, women and grandmothers explored motivators and barriers to uptake of male HIV testing.ResultsHIV incidence rate was estimated at 4.28/100 women-years (95%CI: 2.33–7.16). Significant risk factors for HIV acquisition were early sexual debut (RR 3.79, 95%CI: 1.04–13.78, p = 0.04) and living in Maputo Province (RR 4.35, 95%CI: 0.97–19.45, p = 0.05). Nineteen percent of women reported that their partner had tested for HIV (93% knew the result with 8/213 indicating an HIV positive partner), 56% said their partner had not tested and 19% did not know their partner test status. Of the 14 seroconversions, only one reported being in a serodiscordant relationship. Fear of discrimination or stigma was reported as a key barrier to male HIV testing, while knowing the importance of getting tested and receiving care was the main motivator.ConclusionsHIV incidence during pregnancy is high in Southern Mozambique, but knowledge of partners' HIV status remains low. Knowledge of both partners' HIV status is critical for maximal effectiveness of prevention and treatment services to reach elimination of pediatric HIV/AIDS.
Highlights
Prevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV
A total of 1230 pregnant women were enrolled in the cohort with 151 (12%) lost to follow-up (LFU) after the enrollment visit and an additional 188 (15%) as they missed their last study visit at delivery (Fig. 1)
A recent metaanalysis on HIV incidence during pregnancy and postpartum did not show significant differences in the pooled incidence rates during pregnancy compared to postpartum period (4.7 per 100 women-years during pregnancy versus 2.9 per 100 women-years during the postpartum period) [2]
Summary
Prevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV. Identification and support for HIV negative pregnant women and their partners, serodiscordant couples, are critical. Prevention of mother-to-child transmission (PMTCT) of HIV includes prevention of incident infection among women of reproductive age, especially during pregnancy [1]. Women during pregnancy and the postpartum period have an increased risk of acquiring HIV, similar to high-risk sub-populations, such as female sex workers, men having sex with men and known serodiscordant couples [2]. Strong preventive services, including identification of serodiscordancy among pregnant couples is crucial to decrease HIV transmission. Most PMTCT programs have achieved high rates of initial HIV testing, with periodic repeat testing recommended for HIV negative pregnant women. The national PMTCT program includes opt-out testing for pregnant women, with all women encouraged to invite their partners for HIV testing at the clinic. Reasons for the low uptake of male partner testing were not assessed
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