Abstract
The aim was to assess population-level HIV-testing uptake among pregnant women, key for access to prevention-of mother to child transmission (PMTCT) services, and to identify risk factors for not being HIV tested,The study was conducted May 2008–May 2010 in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS), Eastern Uganda, during regular surveillance of 68,000 individuals. All women identified to be pregnant May–July 2008 (n = 881) were interviewed about pregnancy-related issues and linked to the HDSS database for socio-demographic data. Women were followed-up via antenatal care (ANC) register reviews at the health facilities to collect data related to ANC services received, including HIV testing. Adjusted relative risk (aRR), and 95% confidence intervals (CI) for not being HIV tested were calculated using multivariable binomial regression among the 544 women who remained after record review.Despite high ANC attendance (96%), the coverage of HIV testing was 64%. Only 6% of pregnant women who sought ANC at a facility without HIV testing services were referred for testing and only 20% received counseling regarding HIV. At ANC facilities with HIV testing services, 85% were tested. Only 4% of the women tested had been couple tested for HIV. Living more than three kilometers away from a health facility with HIV testing services was associated with not being tested both among the poorest (aRR,CI; 1.44,1.02–2.04) and the least poor women (aRR,CI;1.72,1.12–2.63).The lack of onsite HIV testing services and distant ANC facilities lead to missed opportunities for PMTCT, especially for the poorest women. Referral systems for HIV testing need to be improved and testing should be expanded to lower level health facilities. This is in order to ensure that the policy of HIV testing during pregnancy is implemented more effectively and that testing is accessible for all.
Highlights
An estimated 17,000 children in Uganda were infected with HIV through mother-to-child transmission (MTCT) in 2009, despite a stable HIV prevalence of 7.5% among women of reproductive age (15–49 years) and high (94%) uptake of antenatal care (ANC) [1,2]
Only 64% (371/579) of the women were HIV tested during the current pregnancy
ANC and HIV testing by health facility Figure 3 shows the proportion of women tested for HIV by the type of health facility
Summary
An estimated 17,000 children in Uganda were infected with HIV through mother-to-child transmission (MTCT) in 2009, despite a stable HIV prevalence of 7.5% among women of reproductive age (15–49 years) and high (94%) uptake of antenatal care (ANC) [1,2]. In low-income countries with limited access to combination ARV regimens or the capacity to provide cesarean section and replacement feeding, the rate of MTCT can still be reduced to around 5%, provided that women are tested, enrolled in and complete the PMTCT program [5,6,7]. The World Health Organization (WHO) recommends that countries with generalized HIV epidemics implement opt-out or provider-initiated HIV testing during ANC to increase likelihood of HIV testing among pregnant women [12]. The Ugandan national policy guidelines for PMTCT recommends that all pregnant women are counseled and tested for HIV during ANC, provided they do not actively opt-out, or referred for testing if onsite services are not available [19]. But so far with limited success in practice, joint couple HIV testing including the pregnant woman and her spouse has been introduced in Uganda, hoping to expand the coverage of HIV testing and to reduce barriers to accessing PMTCT services [20,21,22,23,24]
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