Implementation of HIV Retesting During Pregnancy and Postpartum in Kenya: A Cross-Sectional Study.

Monalisa Penumetsa,Barbra A Richardson,Daniel Matemo,Jillian Neary,Shiza Farid,Peninah Kithao,John Kinuthia,Grace John-Stewart,Alison L Drake

doi:10.9745/ghsp-d-21-00451

Monalisa Penumetsa, Barbra A Richardson + Show 7 more

Open Access

https://doi.org/10.9745/ghsp-d-21-00451

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Abstract

HIV retesting during pregnancy/postpartum can identify incident maternal HIV infection and prevent mother-to-child HIV transmission (MTCT). Guidelines recommend retesting HIV-negative peripartum women, but data on implementation are limited. We conducted a cross-sectional study in Kenya to measure the prevalence of maternal HIV retesting in programs and HIV incidence. Programmatic HIV retesting data was abstracted from maternal and child health booklets among women enrolled in a cross-sectional and/or seeking services during pregnancy, delivery, or 9 months postpartum in Kenya between January 2017 and July 2019. Retesting was defined as any HIV test conducted by MTCT programs after the initial antenatal care test or conducted as part of retesting policies at/after delivery for women not tested during pregnancy. Poisson generalized linear regression was used to identify correlates of programmatic retesting among women enrolled at 9 months postpartum. Among 5,894 women included in the analysis, 3,124 only had data abstracted and 2,770 were enrolled in a cross-sectional study. Overall prevalence of programmatic HIV retesting was higher at 6 weeks (65%) and 9 months postpartum (72%) than in pregnancy (32%), at delivery (23%) and 6 months postpartum (28%) (P<.001 for all comparisons). HIV incidence was 0.72/100 person-years (PY) (95% confidence interval (CI)=0.43,1.22) in pregnancy and 0.23/100 PY (95% CI=0.09, 0.62) postpartum (incidence rate ratio: 3.09; 95% CI=0.97, 12.90; P=.02). Maternal retest coverage was high at 6 weeks and 9 months postpartum but low during pregnancy. Strategies to ensure high retesting coverage and detect women with incident maternal HIV infection are needed.

Highlights

HIV retesting during pregnancy/postpartum can identify incident maternal HIV infection and prevent mother-to-child HIV transmission (MTCT)
As MTCT risk decreases among women with chronic infection who are effectively treated with antiretroviral therapy (ART), the proportion of infant HIV infections attributed to women who acquire HIV infection during pregnancy or postpartum increases.[3]
The number of antenatal care (ANC) and postnatal care (PNC) visits were dichotomized based on the expected number of ANC visits (n=4) and median number of PNC visits among women enrolled at 9 months postpartum in the programmatic abstraction only study

Summary

Introduction

HIV retesting during pregnancy/postpartum can identify incident maternal HIV infection and prevent mother-to-child HIV transmission (MTCT). Methods: Programmatic HIV retesting data was abstracted from maternal and child health booklets among women enrolled in a cross-sectional and/or seeking services during pregnancy, delivery, or 9 months postpartum in Kenya between January 2017 and July 2019. HIV incidence is high among pregnant and postpartum women, estimated at 2.1/100 personyears (PY) in studies conducted after 2014 in subSaharan Africa.[2] As MTCT risk decreases among women with chronic infection who are effectively treated with ART, the proportion of infant HIV infections attributed to women who acquire HIV infection during pregnancy or postpartum increases.[3] Incident maternal HIV infections are associated with nearly a 10-fold higher risk of MTCT, in the context of universal ART,[4] with MTCT rates ranging from 36%–53%.5–7. In the absence of maternal HIV retesting, pregnant and postpartum women who initially test HIVnegative during ANC but acquire HIV later, have undetected infection and miss benefits from PMTCT interventions Incident maternal HIV infections are associated with nearly a 10-fold higher risk of MTCT, in the context of universal ART,[4] with MTCT rates ranging from 36%–53%.5–7 In the absence of maternal HIV retesting, pregnant and postpartum women who initially test HIVnegative during ANC but acquire HIV later, have undetected infection and miss benefits from PMTCT interventions

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