Abstract
ObjectiveTo describe the uptake of and factors associated with HIV prevalence among pregnant women in a large-scale home-based HIV counseling and testing (HBCT) program in western Kenya.MethodsIn 2007, the Academic Model Providing Access to Healthcare Program (AMPATH) initiated HBCT to all individuals aged ≥13 years and high-risk children <13 years. Included in this analysis were females aged 13–50 years, from 6 catchment areas (11/08-01/12). We used descriptive statistics and logistic regression to describe factors associated with HIV prevalence.ResultsThere were 119,678 women eligible for analysis; median age 25 (interquartile range, IQR: 18–34) years. Of these, 7,396 (6.2%) were pregnant at the time of HBCT; 4,599 (62%) had ever previously tested for HIV and 2,995 (40.5%) had not yet attended ANC for their current pregnancy. Testing uptake among pregnant women was high (97%). HBCT newly identified 241 (3.3%) pregnant HIV-positive women and overall HIV prevalence among all pregnant women was 6.9%. HIV prevalence among those who had attended ANC in this pregnancy was 5.4% compared to 9.0% among those who had not. Pregnant women were more likely to newly test HIV-positive in HBCT if they had not attended ANC in the current pregnancy (AOR: 6.85, 95% CI: 4.49–10.44).ConclusionsPregnant women who had never attended ANC were about 6 times more likely to newly test HIV-positive compared to those who had attended ANC, suggesting that the cascade of services for prevention of mother-to-child HIV transmission should optimally begin at the home and village level if elimination of perinatal HIV transmission is to be achieved.
Highlights
A majority of pregnant women living with HIV in the world are from sub-Saharan Africa, and it is estimated that only 68% of them received antiretroviral therapy prophylaxis during pregnancy and delivery in 2013.[1]
HIV prevalence among those who had attended antenatal care (ANC) in this pregnancy was 5.4% compared to 9.0% among those who had not
Pregnant women who had never attended ANC were about 6 times more likely to newly test HIV-positive compared to those who had attended ANC, suggesting that the cascade of services for prevention of mother-to-child HIV transmission should optimally begin at the home and village level if elimination of perinatal HIV transmission is to be achieved
Summary
A majority of pregnant women living with HIV in the world are from sub-Saharan Africa, and it is estimated that only 68% of them received antiretroviral therapy prophylaxis during pregnancy and delivery in 2013.[1]. Only 58% of women in Kenya are estimated to attend the minimum recommended four antenatal care visits, and 40% attend their first ANC visit after 6 months gestation.[8, 9] Evidence shows that HIV-positive women receiving combination antiretroviral prophylaxis during pregnancy, delivery and breastfeeding can reduce mother-to-child transmission to less than 5%.[10] In addition to PMTCT services which target pregnant women and offer a provider-initiated approach to HIV testing, there are a number of other strategies that provide pregnant women with opportunities to know their HIV status, including home-based counseling and testing (HBCT). In addition to PMTCT services which target pregnant women and offer a provider-initiated approach to HIV testing, there are a number of other strategies that provide pregnant women with opportunities to know their HIV status, including home-based counseling and testing (HBCT). [11, 12]
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