Abstract
In sub-Saharan Africa, most women who test HIV negative at the first antenatal care encounter are rarely tested again during pregnancy and postpartum, yet data suggests that pregnancy is associated with increased risk of HIV acquisition compared to non-pregnant women. We describe HIV incidence during pregnancy and postpartum in Lesotho, a high prevalence setting, and factors associated with HIV seroconversion. We enrolled a cohort of HIV negative women presenting at health facilities for antenatal care and followed them through delivery up to 24 months postpartum. Women were repeatedly tested for HIV according to the Lesotho Ministry of Health routine rapid HIV testing guidelines and responded to risk behavior questionnaire every three months. We estimated HIV incidence and associated 95% confidence intervals. We used mixed effects Cox regression models to identify independent factors associated with seroconversion accounting for repeated assessment. The estimated overall HIV incidence rate was 1.58 (95% CI: 1.05–2.28) per 100 person- years. The estimated HIV incidence rate during pregnancy (2.61 per 100 person-years, 95% CI: 1.12–5.14) was almost double the estimated HIV incidence during postpartum (1.36 per 100 person-years, 95% CI: 0.83–2.10). Women’s age (14–24 years compared to 25–45 years), multiple sexual partnerships, urethral discharge and no condoms nor pre-exposure prophylaxis were independently associated with HIV infection. There is an increased need for counseling and support of HIV-uninfected pregnant and breastfeeding women to stay HIV-negative, including provision of pre-exposure prophylaxis during this high-risk period, particularly among adolescent and young women.
Highlights
In many sub-Saharan African countries, women and their partners who test HIV-negative at the first ANC contact are rarely tested again during pregnancy or postpartum despite WHO recommendations and national guidelines that state that repeat HIV testing should be conducted in ANC and postnatal care (PNC) [1], remaining at risk for acquiring HIV infection during their pregnancy and while breastfeeding[2]
Our results suggest that annual HIV incidence is higher during pregnancy (2.61%) compare to post-partum (1.36%)
Our results suggest there is a need to strengthen HIV prevention approaches during pregnancy and postpartum within this population including pre-exposure prophylaxis, regular HIV testing of pregnant and breastfeeding women as well their partners, and immediate initiation of infant ARV prophylaxis
Summary
Prevention of mother-to-child transmission (PMTCT) programs have been successful at identifying pregnant women infected with HIV when they present for their first antenatal (ANC). HIV incidence in pregnant and postpartum women visit and initiating preventive measures to limit the transmission of HIV to their infants. Data suggest that pregnancy is associated with an increased risk of HIV acquisition compared to non-pregnant women[3][4]. A meta-analysis of data from 19 African studies estimated the pooled HIV incidence rate during pregnancy was 4.7 per 100 person-years and 2.9 per 100 personyears during the postpartum period[7]. Acute HIV infection is characterized by high viral load[8], and may increase the risk of HIV transmission to infants[7]
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