Number and timing of antenatal HIV testing: evidence from a community-based study in Northern Vietnam.

Vibeke Rasch,Tine M Gammeltoft,Nguyen T T Hanh

doi:10.1186/1471-2458-11-183

Vibeke Rasch, Tine M Gammeltoft + Show 1 more

Open Access

https://doi.org/10.1186/1471-2458-11-183

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Abstract

BackgroundHIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been scaled up to reach first level health facilities.MethodsA cross-sectional community-based study was conducted among 1108 recently delivered mothers through face-to-face interviews following a structured questionnaire that focused on socio-economic characteristics, experiences of antenatal care and HIV testing.ResultsThe prevalence of women who lacked HIV testing among the study group was 10% while more than half of the women tested had had more than two tests during pregnancy. The following factors were associated with the lack of antenatal HIV test: having two children (aOR 2.1, 95% CI 1.3-3.4), living in a remote rural area (aOR 7.8, 95% CI 3.4-17.8), late antenatal care attendance (aOR 3.6, 95% CI 1.3-10.1) and not being informed about PMTCT at their first antenatal care visits (aOR 7.4, 95% CI 2.6-21.1). Among women who had multiple tests, 80% had the second test after 36 weeks of gestation. Women who had first ANC and first HIV testing at health facilities at primary level were more likely to be tested multiple times (OR 2.9 95% CI 1.9-4.3 and OR = 4.7 95% CI 3.5-6.4), respectively.ConclusionsNot having an HIV test during pregnancy was associated with poor socio-economic characteristics among the women and with not receiving information about PMTCT at the first ANC visit. Multiple testing during pregnancy prevailed; the second tests were often provided at a late stage of gestation.

Highlights

HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT)
Recent studies from Hanoi revealed that poor antenatal counselling and lack of HIV counseling and testing (HCT) services at community level, as well as being offered HIV testing at a late stage of pregnancy resulted in women not being tested for HIV during antenatal care (ANC) [14,26]
The results of this study showed that a lack of HIV test during pregnancy was associated with poor socioeconomic status and with lack of information and offering HCT services at the first ANC visit

Summary

Introduction

HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). This study aims to assess the number and timing of antenatal HIV testing in a lowincome setting where PMTCT programmes have been scaled up to reach first level health facilities. The rates of HIV infection among pregnant women in Asia are not high, generally 1-2% [6] and the epidemic is mainly concentrated in high risk populations, known to be HIV counseling and testing (HCT) during pregnancy is an important initial component for successful PMTCT. In spite of efforts made to scale up PMTCT in areas hard hit by the HIV epidemic, a lack of HIV testing during pregnancy has been reported from several studies. The main barriers to HCT included difficult access to antenatal care (ANC), unavailability of HCT services, lack of knowledge on PMTCT, fear of stigma if found to be HIV positive, and lack of awareness about HCT due to limited communication between women and providers during ANC [5,13,14,15]

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