HIV Testing Of Pregnant Women Research Articles

THE RELATIONSHIP BETWEEN THE ROLE OF HEALTH WORKERS AND MOTIVATION FOR HIV/AIDS TESTING IN PREGNANT WOMEN

HIV infection in pregnant women can harm both mother and child and more than 90% of cases of children with HIV are transmitted from mother to child. Motivation related to HIV testing in pregnant women is still very low, seen from when health workers offer HIV tests to all pregnant women who are visiting Antenatal Care. The purpose of this study is to determine the relationship between the role of health workers and the motivation for HIV/AIDS examination for pregnant women at the Campurejo Health Center, Mojoroto District, Kediri City in 2023. This type of research is quantitative using a crossectional design. By using the Simple Random Sampling sampling technique, the samples in this study were some pregnant women at the Campurejo Health Center, Mojoroto District, Kediri City amounting to 30 people. The data collection instrument in this study used a questionnaire sheet instrument. The research was conducted at the Campurejo Health Center, Mojoroto District, Kediri City. Bivariate analysis in this study used the spearman rho test. The results showed that almost half of the respondents who rated the role of health workers in the sufficient category were 14 respondents (46%), and some respondents had high motivation towards HIV/AIDS testing, namely 20 respondents (67%). The results of the statistical test of the correlation of Sperman Rho with a level of meaning p < 0.05 showed a relationship between the role of health workers and the motivation of pregnant women to be tested for HIV / AIDS at the Campurejo Health Center, Mojoroto District, Kediri City with p = 0.034 and r = 0.387. It is expected that health workers will always improve the quality of services providing counseling to clients, especially regarding HIV/AIDS examinations. Keywords: screening, HIV/AIDS, pregnant

Characteristics and communication skills of health professionals in implementing provider-initiated HIV testing and counselling (PITC) for Indonesian pregnant women

Background: HIV testing for pregnant women is an important test during pregnancy. HIV testing for pregnant women is a way to prevent mother-to-child HIV transmission. Objectives: To investigate the relationship between the characteristics and communication skills of health professionals while conducting provider-initiated HIV testing and counselling (PITC) for pregnant women. Methods: This was an observational study with a cross-sectional approach. The study was conducted at 23 public health centres with 80 health professionals who conduct PITC. The data was analysed using the Chi-Square test. Results: There was a correlation between the characteristics and communication skills of respondents. Relationships were observed between respondents trained on PITC and communication with patients during PITC sessions (p=0.002); work experience and non-verbal communication skills (p=0.047), and type of profession of respondents and non-verbal communication skills (p=0.029). Conclusions: Communication skills had a relationship with experienced training on PITC, work experience, and type of profession. Increasing the communication skill of health professionals through work experience and training or education to improve the ability of health professionals in PITC services.

Recommend Guideline on Prevention of Mother-to-Child Transmission of HIV in China in 2020

Abstract In China, a pilot project for the prevention of mother-to-child transmission (PMTCT) of the HIV was initiated in 2001. For the PMTCT of HIV, the Chinese government has released versions of the guidelines since 2004. In 2014, the World Health Organization released guidance on global processes and criteria for the validation of elimination of mother-to-child transmission of HIV and syphilis. To promote the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B virus in China, the Chinese government updated the Guideline for PMTCT of HIV, Syphilis, and Hepatitis B in 2020 (briefly as Guideline-2020). The Guideline-2020 comprises 5 parts: goals, interventions, support measures, duties and cooperation of departments, and definition indicators for PMTCT of HIV and corresponding calculation formulas. Compared with the previous versions, the key points updated in the Guideline-2020 are that the goals are set again, and health education and promotion, the procedure of HIV testing for pregnant women, and the antiretroviral therapy regimen for HIV-positive pregnant women and antiretroviral) prophylaxis regimen for infants are all updated. The antiretroviral prophylaxis regimen as zidovudine-lamivudine-nevirapine/lopinavir/ritonavir twice per day for 6 weeks is recommended for infants at high exposure risk to HIV, whereas the third antiretroviral therapy regimen as tenofovir-lamivudine-lopinavir/ritonavir is recommended for HIV-positive pregnant women, and indicators for PMTCT of HIV and corresponding calculation formulas are defined.

Improving access to HIV testing for pregnant women in community birth centres in Nigeria: an evaluation of the Prevention of Mother-to-Child Transmission program.

The elimination of mother-to-child HIV transmission requires access to HIV testing services (HTS) for pregnant women. In Akwa Ibom, Nigeria, 76% of pregnant women receive antenatal care from traditional birth attendants and may not have access to HIV testing. This study examines the contribution of traditional birth attendants and other healthcare workers in community birth centres in improving access to HTS among pregnant women and their HIV-exposed infants. A retrospective cross-sectional study of previously collected programme data at two points in time to evaluate the prevention of mother-to-child transmission (PMTCT) programme. We assessed programme records before and after introducing an intervention that engaged traditional birth attendants and other healthcare workers in community birth centres to expand access to HTS among pregnant women and their HIV-exposed infants in Akwa Ibom State, Nigeria. Data were abstracted from the programme database for the preintervention period (April 2019 to September 2020) and the intervention period (October 2020 to March 2022). Data abstracted include the number of pregnant women tested for HIV, those diagnosed with HIV, the number of HIV-exposed infants who had samples collected for early infant diagnosis and those diagnosed with HIV. The data were analysed descriptively and inferentially. Before the intervention, 39,305 pregnant women and 2248 HIV-exposed infants were tested for HIV. After the intervention, the number of pregnant women tested increased to 127,005 and the number of HIV-exposed infants tested increased to 2490. Among pregnant women, the postintervention testing increased by 3.2-fold, with community birth centres reporting 63% of all tests. The intervention also resulted in an 11% increase in HIV-exposed infants benefitting from early infant diagnosis with community birth centres reporting 5% of all tests. Of those diagnosed with HIV, 24% of pregnant women and 12% of infants were diagnosed at community birth centres. Community-based HIV testing for pregnant women can reduce mother-to-child transmission and improve early diagnosis and treatment of exposed infants. Collaboration with birth attendants is crucial to ensure testing opportunities are not missed. Prospective research is needed to understand the clinical outcomes of intervention programmes in the community.

Financial Incentives, Not Behavioral Nudges, Led to Optimized HIV Testing among Pregnant Women in a High-Burden Urban Population in Ecuador.

Behavioral economic principles are increasingly being used in the fight against HIV, including improving voluntary testing in sub-Saharan Africa and South America. However, behavioral nudges have not been widely tested as a strategy to optimize HIV testing in pregnant women. Here, we assessed whether behavioral nudges or financial incentives were effective in optimizing HIV testing among pregnant women in a high-HIV burden setting. A randomized clinical trial was conducted between May 21 and Oct 5, 2018, to allocate pregnant women in Ecuador into three study arms: information only, soft commitment (i.e., a behavioral nudge), and financial incentives. All participants received an informational flyer, including the address of a testing location. Participants in the soft-commitment arm signed and kept a form on which they committed to get tested for HIV. Those in the financial incentive arm received a $10 incentive when tested for HIV. A stepwise logistic regression analysis estimated the effect of the study arms on HIV testing rate. Participants in the financial-incentive arm had higher odds of getting an HIV test (adjusted odds ratio 17.06, P < 0.001) as compared with information-only participants. Soft-commitment had the opposite effect (adjusted odds ratio 0.14, P = 0.014). Financial incentives might be useful in improving HIV testing among pregnant women, especially among those who might be at higher risk but who have not completed an HIV test.

HIV Test in Pregnancy - 100% Not Reached in 2020

In 2019 38 million people were living with HIV worldwide, more than half of them girls and women. Knowledge about maternal HIV status enables HIV transmission prophylaxis, reducing mother-to-child transmission<1%. We aimed to investigate the implementation of the mandatory documentation of counseling and optional HIV testing in the maternity records as recommended in the German maternity guidelines. In the Obstetric Department of the University Hospital Bonn, maternity records were reviewed from June to October 2020, and pregnant women were interviewed regarding the patients' recall of counseling and HIV testing as well as their attitude towards a universal screening strategy using an anonymous questionnaire. Documentation was incomplete in 11% of maternal records: in 8% there was neither documentation of counseling nor of HIV testing, in 3% documentation of counseling only. In 291 questionnaires 47% of pregnant women could not recall counselling. 90% of pregnant women were in favor of universal HIV testing in pregnancy, 9% were undecided, and 1% opposed it. 55% would support change from an "opt-in" to an "opt-out" screening policy in pregnancy. Documentation of counseling and HIV testing was incomplete in 11% of cases, and nearly half of the women could not recall counselling. New strategies from midwives and obstetricians need to be developed to achieve universal HIV testing in pregnant women leading to zero HIV mother-to-child transmissions.

Improving Pregnant Mothers’ Intention toward HIV Testing through Home-based HIV Test and Education (HOPE) in Jember, Indonesia

The HIV testing program's implementation among pregnant mothers is still not going well due to their intention. Their intention is needed because it can affect pregnant mothers' behavior toward HIV testing. New interventions are needed to solve this problem, such as Home-based HIV Test and Education (HOPE). This study aimed to analyze the influence of HOPE to improve HIV testing intention among pregnant mothers. The pre-experimental design was used with one group pretest-posttest approach—thirty pregnant mothers in Jember following this study and involved by using a purposive sampling technique. The data were collected by using the intention questionnaire and analyzed with the Wilcoxon test. The result showed that pregnant mothers' intention of HIV testing numbers increased from 20 to 27. The results indicate that there is a significant influence of HOPE on the intention of HIV testing in pregnant women (p = 0.033). The Home-based HIV Test and Education (HOPE) intervention can improve pregnant mothers' intention toward HIV testing. The HOPE intervention can reach all pregnant mothers (and their husbands) to discover HIV testing information. Involving their husbands on HOPE intervention encouraged pregnant mothers' intention of HIV testing because their husbands were decision-makers in their family, and pregnant mothers will take HIV testing.

REACHING THE UNREACHED: UNIVERSAL ACCESS TO HIV TESTING FOR PREGNANT WOMEN THROUGH COMMUNITY BASED TESTING IN WEST BENGAL, INDIA

Reaching the unreached: Universal access to HIV testing for pregnant women through Community Based Testing in West Bengal, India - IJAR - Indian Journal of Applied Research(IJAR) IJAR is a double reviewed monthly print journal that accepts research works

KNOWLEDGE &amp; AWARENESS OF HIV TESTING IN PREGNANT WOMEN AND THEIR HUSBAND ATTENDING OBSTETRICS &amp; GYNAECOLOGY DEPARTMENT AT A TERTIARY CARE CENTRE IN CENTRAL INDIA DURING ANTENATAL CARE

Background: 3.4 million people worldwide are estimated to be living with HIV in 2009. In 2007, only 33 percent of HIV-positive women received antiretroviral drugs to minimise the risk of infection from mother to child.&#x0D; Aims and Objective: To study Awareness of HIV testing in pregnant women and their husband during ANC attending in OBGY Department.&#x0D; Methodology: This was a cross-sectional analysis carried out over the one-year period of the ANC women attending the OBGY department. By taking the written consent included in the report, there were 108 ANC women in the one year period. By interviewing the pair, knowledge of HIV testing and HIV transmission was assessed. The responses were noted and evaluated by excel software for Windows 10 in the excel sheet.&#x0D; Result: In our study we have seen that the majority of the ANC women were in the age group of 26-30 were 32 %. The awareness regarding the various questions like Does HIV transmitted to foetus by mother?- 9 % were Yes, 22 %-No, 69 %-Don’t Know; Do you know tests are there for detection of HIV?- 7 %-Yes, 13 %-No, 80 %-Don’t know; Are you at a risk of Infection?- 4% were Yes, 52% -No, 44 % were Don’t know; Can the disease prevented ? 6 %- Yes, 22 % were No, 72 % were don’t know; Is HIV a Sexually transmitted disease? 33 %-Yes, 22 %-No, 45 %-Don’t know; Can HIV be transmitted by contaminated blood? 32 %-Yes, 20 %-No, 48 %-Don’t know; Can HIV be transmitted by Kissing ?-35 % say Yes, 17 % -No, 48 %-Don’t know; Can HIV be transmitted by sharing food ?- 24 % Yes , 35 %-No, 41 %-Don’t know. From our research, we found that while there is good understanding of the HIV disease, the availability of preventive services through HIV testing is very poor, so subsequent prevention administration drugs are very low, although some myths about the transmission of the disease still remain, such as transmitting through sharing food or transmitting casual hugging or shaking.&#x0D; Conclusion: From our research, it can be concluded that the awareness of the PPTCT services with respect to HIV testing during the ANC era was very low, so that the awareness of it should be increased so that HIV transmission from mother to foetus can be effectively carried out.&#x0D; Key words: HIV testing during pregnancy, PPTCT (Prevention of Parent to Child Transmission)

False reactive HIV rapid antibody test in pregnancy

Background: Universal screening of HIV infection in pregnant women is recommended by CDC as well as Indonesia Ministry of Health to prevent mother-to-child HIV transmission. Algorithm of HIV testing in pregnant women in Indonesia is similar to that in Integrated Counseling and Testing Centre (ICTC) which refes to WHO HIV Testing Strategy III. Pregnancy has been observed to be associated with false positive HIV testing that can cause serious emotional distress and unnecessary follow-up. Case Description: A 21 y old pregnant woman was referred to a tertiary hospital with premature rupture of the membranes. Before C-section, preoperative laboratory test panels were ordered, including for HIV to which she consented. A rapid HIV test (A1) was performed and tested reactive for antibodies against HIV. The second (A2) and third (A3) rapid tests were then performed and yielded non-reactive results, concluding the final result as negative. Reassessment of the patients showed no risk factors for HIV infection. This was the third case of reactive A1 with non-reactive A2 and A3 within the last year in the hospital. After confirmatory tests, which came back non-reactive and negative for fourth-generation HIV test and Western Blot, respectively, the A1 test was considered as false positive. Discussion: Based on several reports, there are alloantibodies in pregnancy, transfusions, transplantations, and autoimmune diseases that account for the increased false positive rate. Positive HIV antibody test results can occur in the absence of infection due to cross-reactivity between viral proteins and tested specimens, but such cross-reactivity is less common using current peptide-based EIAs which contain fewer antigens than previous viral lysate-based EIAs. However, clinicians should be aware that when HIV prevalence is low, as is often the case among pregnant women, a reactive EIA result is more likely to be false positive. Conclusion: Counselling and HIV test should be integrated in antenatal care. Diagnostic procedure of HIV test in pregnant women refers to WHO Testing Strategy III. Because the positive predictive value of HIV test in obstetric population is low, positive screening results should be handled carefully and appropriate confirmatory testing should always be pursued.

Dukungan Petugas Terhadap Perilaku Konseling Dan Tes HIV (Human Immunodeficiency Virus) Ibu Hamil Di Kelurahan Kepanjenlor Kecamatan Kepanjenkidul Kota Blitar

regnant women who received HIV Counseling and Testing (KTHIV) services in the work area of ​​UPTD Puskesmas Kepanjenkidul District in Blitar City in 2018 amounted to 65.12% and the least achievement was Kepanjenlor sub-district which was 37.23%. This study aims to determine the relationship of officer support for HIV pregnant women counseling and testing behavior in Kepanjenlor Village, Kepanjenkidul District, Blitar City. This is a correlation study with a case control survey, using a retrospective approach. The population of pregnant women is 75 with 43 samples taken using simple random sampling technique. Research dated June 17-29, 2019, instruments used questionnaires and medical records, using the Spearman rank statistical test. The results of the study obtained officers support for HIV counseling and testing of pregnant women as many as 31 respondents (72.1%) in the good category, counseling behavior and 29 pregnant women HIV tests (67.4%) were in the good category, and based on statistical tests it was found that p value = 0.002 α &lt;0, 05 and coefficient correlation 0.453 showed there was a relationship between the officers' support for counseling behavior and HIV testing of pregnant women in the Kelurahan Kepanjenlor Kepanjenkidul District, Blitar City. Staff support is needed both emotional support, assessment / appreciation support, information support and instrumental support so that pregnant women have the awareness and willingness to do HIV counseling and testing to find out their HIV status.

Awareness of HIV testing in pregnant women and her husband during ANC attending in OBGY department at JIIUS

Awareness of HIV testing in pregnant women and her husband during ANC attending in OBGY department at JIIUS

Vertical transmission of HIV among pregnant women who initially had false-negative rapid HIV tests in four South African antenatal clinics.

IntroductionThere is a risk of mother-to-child transmission of HIV (MTCT) during pregnancy and breastfeeding. The aim of this study was to assess vertical transmission of HIV among pregnant women who initially had false–negative rapid HIV tests in South African antenatal care (ANC) clinics.MethodsPregnant participants were enrolled in a diagnostic study that used nucleic acid amplification testing (NAAT) to screen for early HIV infection among individuals who tested negative on rapid HIV tests used at the point-of-care (POC) facilities. Participants were enrolled from four ANC clinics in the Tshwane district of South Africa. All NAAT-positive participants were recalled to the clinics for further management. Vertical transmission was assessed among exposed infants whose HIV polymerase chain reaction (PCR) results were available.ResultsThis study enrolled 8208 pregnant participants who tested negative on rapid HIV tests between 2013 and 2016. Their median age was 26 years (interquartile range [IQR]: 23–30). NAAT detected HIV infections in 0.6% (n = 49; 95% confidence interval {CI}: 0.5–0.8) of all study participants. The distribution of these infections among the four clinics ranged from 0.3%– 1.1%, but this was not statistically significant (p = 0.07). Forty-seven participants (95.9%) were successfully recalled and referred for antiretroviral treatment initiation as part of prevention of MTCT (PMTCT). Most women with newly diagnosed HIV infection presented for the first ANC visit in the second (61.9%, n = 26) and third (31.0%, n = 13) trimesters. HIV PCR results were available for thirty-two infants, three of whom tested positive (9.4%; 95% CI: 1.98–25.02).ConclusionsThis study showed that supplemental HIV testing for pregnant women led to earlier linkage to the PMTCT programme. Inaccurate diagnosis of HIV infection at ANC clinics is likely to undermine the efforts of eliminating MTCT particularly in HIV-endemic settings.

Coverage of HIV testing among pregnant women in Nigeria: progress, challenges and opportunities.

This study assessed the progress, opportunities and challenges in scaling up of HIV testing for pregnant women in Nigeria. Data were retrieved from the 2016-2017 fifth multiple cluster survey. Adjusted and unadjusted logistic regression models were used to examine demographic factors associated with HIV testing while controlling for geopolitical zones. At the population level, the coverage of HIV testing among pregnant women increased by 10% points from 32.8 to 42.7% between 2013 and 2017. Also, the coverage of antenatal HIV testing grew by 20 points, from 50.1 to 70.5% over the period. However, women were still more likely to be tested for HIV during pregnancy if they were older than 24years [adjusted odds ratio (AOR) 1.33, 95% CI 1.04-1.69], had higher education [AOR 6.94, 95% CI 5.07-9.49], resided in urban areas [AOR 1.26, 95% CI 1.07, 1.50] and belong to richest wealth quintile [AOR 7.43, 95% CI 5.72-9.66]. Our findings suggest that progress has been made in scaling up of antenatal coverage of HIV testing. However, the level of HIV testing during pregnancy remains low and far below the 95% national target. Appropriate interventions are needed in resource-poor communities where antenatal care utilization is very low.

The MONARCH intervention to enhance the quality of antenatal and postnatal primary health services in rural South Africa: protocol for a stepped-wedge cluster-randomised controlled trial

BackgroundGaps in maternal and child health services can slow progress towards achieving the Sustainable Development Goals. The Management and Optimization of Nutrition, Antenatal, Reproductive, Child Health & HIV Care (MONARCH) study will evaluate a Continuous Quality Improvement (CQI) intervention targeted at improving antenatal and postnatal health service outcomes in rural South Africa where HIV prevalence among pregnant women is extremely high. Specifically, it will establish the effectiveness of CQI on viral load (VL) testing in pregnant women who are HIV-positive and repeat HIV testing in pregnant women who are HIV-negative.MethodsThis is a stepped-wedge cluster-randomised controlled trial (RCT) of 7 nurse-led primary healthcare clinics to establish the effect of CQI on selected routine antenatal and postnatal services. Each clinic was a cluster, with the exception of the two smallest clinics, which jointly formed one cluster. The intervention was applied at the cluster level, where staff received training on CQI methodology and additional mentoring as required. In the control exposure state, the clusters received the South African Department of Health standard of care. After a baseline data collection period of 2 months, the first cluster crossed over from control to intervention exposure state; subsequently, one additional cluster crossed over every 2 months. The six clusters were divided into 3 groups by patient volume (low, medium and high). We randomised the six clusters to the sequences of crossing over, such that both the first three and the last three sequences included one cluster with low, one with medium, and one with high patient volume.The primary outcome measures were (i) viral load testing among pregnant women who were HIV-positive, and (ii) repeat HIV testing among pregnant women who were HIV-negative. Consenting women ≥18 years attending antenatal and postnatal care during the data collection period completed outcome measures at delivery, and postpartum at three to 6 days, and 6 weeks. Data collection started on 15 July 2015. The total study duration, including pre- and post-exposure phases, was 19 months. Data will be analyzed by intention-to-treat based on first booked clinic of study participants.DiscussionThe results of the MONARCH trial will establish the effectiveness of CQI in improving antenatal and postnatal clinic processes in primary care in sub-Saharan Africa. More generally, the results will contribute to our knowledge on quality improvement interventions in resource-poor settings.Trial registrationThis trial was registered on 10 December 2015: www.clinicaltrials.gov, identifier NCT02626351.

Diagnostic accuracy of fourth-generation ARCHITECT HIV Ag/Ab Combo assay and utility of signal-to-cutoff ratio to predict false-positive HIV tests in pregnancy

False-positive HIV screening tests in pregnancy may lead to unnecessary interventions in labor. In 2014, the Centers for Disease Control and Prevention released a new algorithm for HIV diagnosis using a fourth-generation screening test, which detects antibodies to HIV as well as p24 antigen and has a shorter window period compared with prior generations. A reactive screen requires a differentiation assay, and supplemental qualitative RNA testing is necessary for nonreactive differentiation assay. One screening test, the ARCHITECT Ag/Ab Combo assay, is described to have 100% sensitivity and >99% specificity in nonpregnant populations; however, its clinical performance in pregnancy has not been well described. The objective of the study was to determine the performance of the ARCHITECT assay among pregnant women at a large county hospital and to assess whether the relative signal-to-cutoff ratio can be used to differentiate between false-positive vs confirmed HIV infections in women with a nonreactive differentiation assay. This is a retrospective review of fourth-generation HIV testing in pregnant women at Parkland Hospital between June 1, 2015, and Jan. 31, 2017. We identified gravidas screened using the ARCHITECT Ag/Ab Combo assay (index test), with reflex to differentiation assay. Women with reactive ARCHITECT and nonreactive differentiation assay were evaluated with a qualitative RNA assay (reference standard). We calculated sensitivity, specificity, predictive value, and false-positive rate of the ARCHITECT screening assay in our population and described characteristics of women with false-positive HIV testing vs confirmed infection. Among women with a nonreactive differentiation assay, we compared interventions amongwomen with and without a qualitative RNA assay result available at delivery and examined relative signal-to-cutoff ratios of the ARCHITECT assay in women with false-positive vs confirmed HIV infection. A total of 21,163 pregnant women were screened using the ARCHITECT assay, and 190 tested positive. Of these, 33 of 190 (17%) women had false-positive HIV screening tests (28 deliveries available for analysis), and 157 of 190 (83%) had confirmed HIV-1 infection (140 available for analysis). Diagnostic accuracy of the ARCHITECT HIV Ag/Ab Combo assay in our prenatal population (with 95% confidence interval) was as follows: sensitivity, 100% (97.7-100%); specificity, 99.8% (99.8-99.9%); positive likelihood ratio, 636 (453-895); negative likelihood ratio, 0.0 (NA); positive predictive value, 83% (77-88%); and false positive rate, 0.16% (0.11-0.22%), with a prevalence of 7 per 1000. Women with false-positive HIV testing were younger and more likely of Hispanic ethnicity. A qualitative RNA assay (reference standard) was performed prenatally in 24 (86%) and quantitative viral load in 22 (92%). Interventions occurred more frequently in women without a qualitative RNA assay result available at delivery, including intrapartum zidovudine (75% vs 4%, P= .002), breastfeeding delay (75% vs 8%, P= .001), and neonatal zidovudine initiation (75% vs 4%, P= .002). The ARCHITECT signal-to-cutoff ratio was significantly lower for women with false-positive HIV tests compared with those with established HIV infection (1.89 [1.27, 2.73] vs 533.65 [391.12, 737.22], respectively, P < .001). While the performance of the fourth-generation ARCHITECT HIV Ag/Ab Combo assay among pregnant women is comparable with that reported in nonpregnant populations, clinical implications of using a screening test with a positive predictive value of 83% in pregnancy are significant. When the qualitative RNA assay result is unavailable, absence of risk factors in combination with an ARCHITECT HIV Ag/Ab assay S/Co ratio <5 and nonreactive differentiation assay provide sufficient evidence to support deferral of unnecessary intrapartum interventions while awaiting qualitative RNA results.

Evaluation of results-based financing in the Republic of the Congo: a comparison group pre–post study

Results-based financing (RBF) has been advocated and increasingly scaled up in low- and middle-income countries to increase utilization and quality of key primary care services, thereby reducing maternal and child mortality rates. This pilot RBF study in the Republic of the Congo from 2012 to 2014 used a quasi-experimental research design. The authors conducted pre- and post-household surveys and gathered health facility services data from both intervention and comparison groups. Using a difference-in-differences approach, the study evaluated the impact of RBF on maternal and child health services. The household survey found statistically significant improvements in quality of services regarding the availability of medicines, perceived quality of care, hygiene of health facilities and being respected at the reception desk. The health facility survey showed no adverse effects and significantly favourable impacts on: curative visits, patient referral, children receiving vitamin A, HIV testing of pregnant women and assisted deliveries. These improvements, in relative terms, ranged from 42% (assisted deliveries) to 155% (children receiving vitamin A). However, the household survey found no statistically significant impacts on the five indicators measuring the use of maternal health services, including the percentage of pregnant women using prenatal care, 3+ prenatal care, postnatal care, assisted delivery, and family planning. Surprisingly, RBF was found to be associated with a reduction of coverage of the third diphtheria, pertussis, and tetanus immunization among children in the household survey. From the health facility survey, no association was found between RBF and full immunization among children. Overall, the study shows a favourable impact of an RBF programme on most, but not all, targeted maternal and child health services. Several aspects of programme implementation, such as timely disbursement of incentives, monitoring health facility performance, and transparency of using funds could be further strengthened to maximize RBF's impact.

Statistical models for incorporating data from routine HIV testing of pregnant women at antenatal clinics into HIV/AIDS epidemic estimates.

HIV prevalence data collected from routine HIV testing of pregnant women at antenatal clinics (ANC-RT) are potentially available from all facilities that offer testing services to pregnant women and can be used to improve estimates of national and subnational HIV prevalence trends. We develop methods to incorporate these new data source into the Joint United Nations Programme on AIDS Estimation and Projection Package in Spectrum 2017. We develop a new statistical model for incorporating ANC-RT HIV prevalence data, aggregated either to the health facility level (site-level) or regionally (census-level), to estimate HIV prevalence alongside existing sources of HIV prevalence data from ANC unlinked anonymous testing (ANC-UAT) and household-based national population surveys. Synthetic data are generated to understand how the availability of ANC-RT data affects the accuracy of various parameter estimates. We estimate HIV prevalence and additional parameters using both ANC-RT and other existing data. Fitting HIV prevalence using synthetic data generally gives precise estimates of the underlying trend and other parameters. More years of ANC-RT data should improve prevalence estimates. More ANC-RT sites and continuation with existing ANC-UAT sites may improve the estimate of calibration between ANC-UAT and ANC-RT sites. We have proposed methods to incorporate ANC-RT data into Spectrum to obtain more precise estimates of prevalence and other measures of the epidemic. Many assumptions about the accuracy, consistency, and representativeness of ANC-RT prevalence underlie the use of these data for monitoring HIV epidemic trends and should be tested as more data become available from national ANC-RT programs.

Modeling the Cost-Effectiveness of Home-Based HIV Testing and Education (HOPE) for Pregnant Women and Their Male Partners in Nyanza Province, Kenya.

Women in sub-Saharan Africa face a 2-fold higher risk of HIV acquisition during pregnancy and postpartum and the majority do not know the HIV status of their male partner. Home-based couple HIV testing for pregnant women can reduce HIV transmission to women and infants while increasing antiretroviral therapy (ART) coverage in men. However, the cost-effectiveness of this program has not been evaluated. We modeled the health and economic impact of implementing a home-based partner education and HIV testing (HOPE) intervention for pregnant women and their male partners in a region of Western Kenya (formally Nyanza Province). We used data from the HOPE randomized clinical trial conducted in Kisumu, Kenya, to parameterize a mathematical model of HIV transmission. We conducted an in-country microcosting of the HOPE intervention (payer perspective) to estimate program costs as well as a lower cost scenario of task-shifting to community health workers. The incremental cost of adding the HOPE intervention to standard antenatal care was $31-37 and $14-16 USD per couple tested with program and task-shifting costs, respectively. At 60% coverage of male partners, HOPE was projected to avert 6987 HIV infections and 2603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 per disability-adjusted life year averted for the program and task-shifting scenario, respectively. ICERs were robust to changes in intervention coverage, effectiveness, and ART initiation and dropout rates. The HOPE intervention can moderately decrease HIV-associated morbidity and mortality by increasing ART coverage in male partners of pregnant women. ICERs fall below Kenya's per capita gross domestic product ($1358) and are therefore considered cost-effective. Task-shifting to community health workers can increase intervention affordability and feasibility.

Effect of a congregation-based intervention on uptake of HIV testing and linkage to care in pregnant women in Nigeria (Baby Shower): a cluster randomised trial.

Few effective community-based interventions exist to increase HIV testing and uptake of antiretroviral therapy (ART) in pregnant women in hard-to-reach resource-limited settings. We assessed whether delivery of an intervention through churches, the Healthy Beginning Initiative, would increase uptake of HIV testing in pregnant women compared with standard health facility referral. In this cluster randomised trial, we enrolled self-identified pregnant women aged 18 years and older who attended churches in southeast Nigeria. We randomised churches (clusters) to intervention or control groups, stratified by mean annual number of infant baptisms (<80 vs ≥80). The Healthy Beginning Initiative intervention included health education and on-site laboratory testing implemented during baby showers in intervention group churches, whereas participants in control group churches were referred to health facilities as standard. Participants and investigators were aware of church allocation. The primary outcome was confirmed HIV testing. This trial is registered with ClinicalTrials.gov, identifier number NCT 01795261. Between Jan 20, 2013, and Aug 31, 2014, we enrolled 3002 participants at 40 churches (20 per group). 1309 (79%) of 1647 women attended antenatal care in the intervention group compared with 1080 (80%) of 1355 in the control group. 1514 women (92%) in the intervention group had an HIV test compared with 740 (55%) controls (adjusted odds ratio 11·2, 95% CI 8·77-14·25; p<0·0001). Culturally adapted, community-based programmes such as the Healthy Beginning Initiative can be effective in increasing HIV screening in pregnant women in resource-limited settings. US National Institutes of Health and US President's Emergency Plan for AIDS Relief.