Prenatal HIV Research Articles

A Review of Missed Opportunities for Prenatal HIV Screening in a Nationwide Sample of Health Facilities in the Indian Health Service

To better serve our patients, we sought to identify missed opportunities for prenatal HIV screening across Indian Health Service and potential ways to increase screening. Twenty-seven of 161 Federal or Tribal IHS health facilities were randomly selected. Each facility received a standardized set of commands to identify the charts of prenatal patients who were not screened for HIV according to the national Health Information Technology (HIT) platform. We reviewed 598 records at 27 sites of prenatal patients who were identified as not screened for HIV during their pregnancy. According to on-site chart review, nearly half (267/598, 45%) had been screened for HIV, and a slight majority (331/598, 55%) had not been screened. Among the 331 pregnant women not screened for HIV, about half had no HIV screening despite having had ≥2 prenatal care encounters and no screening exclusions (167/331, 50%). A majority of missed opportunities (118/167, 71%) had prenatal testing for other infectious diseases. Based on these results, the National HIV/AIDS program has encouraged increased bundling of HIV with infectious disease tests in prenatal laboratory panels. Improvements in documentation of HIV screening are expected with the IHS transition to electronic health records.

An avoidable transmission of HIV from mother to child

A 29-year-old married woman, an immigrant from sub-Saharan Africa, presented to the Southern Alberta HIV Clinic at week 26 of pregnancy after receiving a positive test result from prenatal HIV screening. She had a university-level education, was fluent in English and agreed to start highly active

Uptake of Prenatal HIV Testing in Hai Phong Province, Vietnam

The objective of the study is to describe the uptake of prenatal HIV testing among Vietnamese women. Exit interviews were conducted among 300 women who had delivered at Hai Phong obstetrical hospital. Information about socioeconomic characteristics and HIV testing was obtained through structured questionnaire interviews. It was found that 45% of the women were tested for HIV before the end of 34 weeks of gestation, 5% in 35 to 40 weeks of gestation, and 55% at labor. Low educational levels, being a farmer or worker, having a low income, and living close to the hospital were associated with being tested at labor. When adjusting for possible confounders, however, living more than 15 km from the hospital was the only factor, which remained significantly associated with HIV testing during labor (odds ratio = 2.15; confidence interval = 1.14-4.04). The results suggest that many Vietnamese women are not tested for HIV during prenatal care and that a relationship exists between distance to the hospital and lack of HIV testing during pregnancy.

Improving prenatal HIV screening with tailored educational interventions: an approach to guideline implementation

BackgroundA healthy, uncomplicated pregnancy undergoes approximately 13 tests performed over an average of 12.5 prenatal visits. Published rates of compliance with routine prenatal testing are generally >90%, with lower rates...

Increasing Use of Rapid HIV Testing in Labor and Delivery Among Women with No Prenatal Care: A Local Initiative

Pregnant women who do not receive prenatal care and may not be aware of their HIV status are at greatest risk of transmitting HIV to their newborn. A multi-component intervention was designed and implemented to increase the use of rapid HIV testing among pregnant women with no prenatal care at labor and delivery in two county hospitals in Houston/Harris County, Texas. The intervention involved establishing a local task force including representatives from each hospital, assessing each hospital's readiness to implement rapid testing, providing educational presentations and materials, and offering individualized follow-up. Outcomes data were obtained and included the number of patients presenting with no prenatal care who received rapid HIV testing on admission. Before the intervention, both hospitals had rapid test kits available but were not using them consistently. Following the intervention, we observed a significant increase in the use of rapid HIV testing at both institutions (P<0.001). In the 3months immediately following the intervention, use of rapid testing at Hospital 1 increased from 7.4 to 35.3% and at Hospital 2 from 27.4 to 41.5%. At 1year, almost 100% of women with no prenatal care at both hospitals received rapid testing. Educating staff and clinicians and implementing system-wide changes may facilitate behavior change regarding prenatal HIV testing.

Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study

BackgroundA large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India.MethodsQuantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants.ResultsIn-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services.ConclusionsOne of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.

Factors Determining Prenatal HIV Testing for Prevention of Mother to Child Transmission of HIV in Mpumalanga, South Africa

This study assessed factors associated with participation in HIV counseling and testing and reported reasons for not taking part in Voluntary HIV Counseling and Testing among 930 pregnant women attending clinics for antenatal care in South Africa. Results indicate that from 930 clients interviewed 87% had agreed to participate in individual pre-test HIV counseling and 81.2% had received their test results in post-test counseling. Fear for taking the test, lack of confidentiality and knowing one's HIV status were the main reasons why women refused to test. In multivariable analysis trust of HCT provider was associated with participation in HIV pre-test counseling and no risky drinking was associated with participation in HIV post-test counseling. These findings suggest mistrust towards HCT providers should be reduced and screening and brief intervention for alcohol problems provided.

ASSOCIATION OF HIV WITH BREAST ABSCESS AND ALTERED MICROBIAL SUSCEPTIBILITY PATTERNS.

BACKGROUND: Breast abscesses account for 15% of surgical day cases seen in the UTH. Nearly all of these cases occur in lactating women. Pre-natal HIV prevalence among women seeking care at UTH was estimated at 25% as of 2004. Baseline surveys have shown that up to 60% of soft tissue infections presenting to the UTH are HIV related. OBJECTIVES: To determine if HIV infection is a risk factor for the development of breast abscesses in women presenting to the University Teaching Hospital (UTH) in Lusaka, Zambia. Secondary objective was to identify bacteriological aetiologies and drug sensitivity patterns associated with breast abscesses at UTH. STUDY DESIGN: A case-control study of 110 consecutive breast-feeding mothers diagnosed with breast abscess upon presentation to the UTH surgical service (cases) and 110 representative controls recruited from the UTH postnatal clinic. MAIN OUTCOMES: HIV seropositivity and CD4 counts (if HIV positive) among cases and controls. RESULTS: Fifty-four out of 110 (49.1%) lactating women with breast abscess had positive serologic tests for HIV. Only 25 of 110 (23%) control women tested HIV positive. This difference was statistically significant, with an odds ratio of 3.28 (95% CI 1.83 - 5.87; p = 0.001). Mean CD4 counts in cases were lower than in controls (338 vs. 568, p<0.001). Staphyloccocus aureus was the main causative agent (91.8%) of isolates. Among S. aureus isolates, 70 of 101 (69.3%) were oxacillin susceptible. Forty-three of 50 (86.0%) specimens from HIV positive patients were resistant to SMX-TMP compared with only 61% of specimens from HIV negative patients (p=0.004). CONCLUSIONS: HIV infection appears to be a significant risk factor in the development of breast abscess in lactating women in Zambia. Staphylococcus aureus remains the main causative agent, with MRSA accounting for 30.7% of isolates. SMX-TPM resistance likely stems from the wide spread use of the drug for PCP prophylaxis in HIV positive patients. It therefore should not be used for treatment of acute bacterial infections. HIV related breast infections could be considered as a possible entry point to HIV treatment now that the CD4 treatment guidelines have been adjusted to 350cells/cmm, although this requires further studies for validation.

650: Cost-effectiveness of prenatal HIV screening strategies in Uganda

Estimate the cost-effectiveness of HIV screening strategies for the prevention of mother-to-child transmission (MTCT) in Uganda, a resource-limited country with high HIV prevalence and incidence. We designed a decision analytic model from a health care system perspective to assess the cost-effectiveness of 4 different HIV screening strategies in pregnancy: 1. Antibody (Ab) at initial visit (current standard of care); 2. Strategy 1 + RNA at initial visit (adds detection of acute HIV); 3. Strategy 1 + repeat Ab at delivery (adds detection of incident HIV); 4. Strategy 3 + RNA at delivery (adds detection of acute HIV at delivery). Model estimates were derived from the literature and local sources, and life years saved were discounted at a rate of 3% per year. Based on World Health Organization guidelines, we defined our cost-effective threshold as 3 times the gross domestic product per capita, which for Uganda was US$3300 in 2008. Using base case estimates of 10% HIV prevalence among women entering prenatal care and 3% incidence during pregnancy, strategy 3 was incrementally the most cost-effective option. Strategy 3 remained the most cost-effective option in sensitivity analysis until the pregnancy incidence rate was >14%, at which point strategy 4 became cost-effective at <$3, 300 per life-year gained. Repeat HIV Ab testing at time of birth is a cost-effective strategy even in a resource-limited setting. Additionally, adding acute HIV testing becomes cost-effective when HIV incidence is >14% in pregnancy.

Knowledge about HIV infection and acceptability of HIV testing among women delivered in Podkarpackie Province, Poland

Objective To assess the knowledge of pregnant Polish women regarding the risk of perinatal HIV transmission, the ways to reduce this risk, and the importance of HIV testing in pregnancy, as well as their willingness to be tested for HIV. Methods A multicenter survey was conducted with 2123 pregnant women from Podkarpackie Province using a 4-part questionnaire. Results Only 15.4% of the women, mainly those with higher education, correctly assessed the risk of perinatal HIV transmission; 61.9% showed adequate knowledge of perinatal HIV transmission, mainly older, well-educated, multiparas residing in towns; and 81.1% declared a willingness to undergo HIV testing, mainly well-educated primigravidas in the 26 to 30 years age group residing in towns. Conclusion These pregnant women from Poland, where prenatal HIV testing is rarely done, showed a limited knowledge of perinatal HIV transmission but a high willingness to undergo HIV testing.

From prenatal HIV testing of the mother to prevention of sexual HIV transmission within the couple

The first step in preventing mother-to-child HIV transmission (PMTCT) programmes is offering HIV counselling and testing to pregnant women. In developing countries where HIV testing remains rare, it represents a unique opportunity for many women to learn their HIV status. This prenatal HIV testing is not only the entry point to prevention of mother-to-child HIV transmission, but also an occasion for women to sensitize their male partner to sexual risks. Here we explore if these women, HIV-tested as mothers, apply the prevention recommendations they also receive as women. In the Ditrame Plus PMTCT program in Abidjan, Côte d'Ivoire, two cohorts of women (475 HIV-infected women and 400 HIV-negative women) were followed up two years after the pregnancy when they were offered prenatal HIV testing. In each cohort, we compared the proportion of women who communicated with their regular partner on sexual risks, prior to and after prenatal HIV testing. We analysed socio-demographic factors related to this communication. We measured two potential conjugal outcomes of women HIV testing: the level of condom use at sex resumption after delivery and the risk of union break-up. Prenatal HIV testing increased conjugal communication regarding sexual risks, whatever the woman's serostatus. This communication was less frequent for women in a polygamous union or not residing with their partner. Around 30% of women systematically used condoms at sex resumption. Among HIV infected ones, conjugal talk on sexual risks was related to improved condom use. After HIV testing, more HIV-infected women separated from their partners than HIV-uninfected women, despite very few negative reactions from the notified partners. In conclusion, offering prenatal HIV counselling and testing is an efficient tool for sensitizing women and their partners to HIV prevention. But sexual prevention in a conjugal context remains difficult and need to be specifically addressed.

Prenatal Screening and Perinatal HIV Transmission in Northern Alberta, 1999–2006

We evaluated the effectiveness of a program that includes routine opt-out prenatal HIV screening, combination antiretroviral therapy (ART), and a multidisciplinary team in preventing perinatal HIV transmission. A retrospective analysis was performed on HIV-infected pregnant women in northern Alberta, Canada, who delivered between January 1, 1999, and February 28, 2006. Ninety-eight women had 113 deliveries. Forty-three percent were diagnosed with HIV infection through prenatal screening. Approximately 60% of HIV-infected pregnant women were Aboriginal, with 45% reporting alcohol use and 42% illicit drug use during pregnancy. The use of combination ART during pregnancy increased throughout the study period; 89% or more received combination ART from 2004 through 2006. Only 1 of the 111 infants (0.9%) was confirmed to be HIV infected, and that infant was born to a woman with no prenatal care. High rates of HIV testing using an opt-out approach, combined with efforts by a multidisciplinary team, resulted in a low rate of perinatal HIV transmission in our cohort. The added value of retesting high-risk women late in pregnancy or with rapid HIV tests at the time of delivery should be explored.

Patient Perspectives with Abbreviated versus Standard Pre-Test HIV Counseling in the Prenatal Setting: A Randomized-Controlled, Non-Inferiority Trial

BackgroundIn the US, an unacceptably high percentage of pregnant women do not undergo prenatal HIV testing. Previous studies have found increased uptake of prenatal HIV testing with abbreviated pre-test counseling, however little is known about patient decision making, testing satisfaction and knowledge in this setting.Methodology/FindingsA randomized-controlled, non-inferiority trial was conducted from October 2006 through February 2008 at San Francisco General Hospital (SFGH), the public teaching hospital of the City and County of San Francisco. A total of 278 English- and Spanish-speaking pregnant women were randomized to receive either abbreviated or standard nurse-performed HIV test counseling at the initial prenatal visit. Patient decision making experience was compared between abbreviated versus standard HIV counseling strategies among a sample of low-income, urban, ethnically diverse prenatal patients. The primary outcome was the decisional conflict score (DCS) using O'Connor low-literacy scale and secondary outcomes included satisfaction with test decision, basic HIV knowledge and HIV testing uptake. We conducted an intention-to-treat analysis of 278 women – 134 (48.2%) in the abbreviated arm (AA) and 144 (51.8%) in the standard arm (SA). There was no significant difference in the proportion of women with low decisional conflict (71.6% in AA vs. 76.4% in SA, p = .37), and the observed mean difference between the groups of 3.88 (95% CI: −0.65, 8.41) did not exceed the non-inferiority margin. HIV testing uptake was very high (97. 8%) and did not differ significantly between the 2 groups (99.3% in AA vs. 96.5% in SA, p = .12). Likewise, there was no difference in satisfaction with testing decision (97.8% in AA vs. 99.3% in SA, p = .36). However, women in AA had significantly lower mean HIV knowledge scores (78.4%) compared to women in SA (83.7%, p<0.01).Conclusions/SignificanceThis study suggests that streamlining the pre-test counseling process, while associated with slightly lower knowledge, does not compromise patient decision making or satisfaction regarding HIV testing.Trial RegistrationClinicalTrials.gov NCT00503308

Refusal of prenatal HIV-testing: a case study in Abidjan (Côte d'Ivoire)

One of the main obstacles to HIV prevention in Africa remains the insufficient number of HIV tests performed. The low percentage of individuals aware of their serostatus is due in part to the insufficient availability of HIV testing, but also to individuals' refusal to have the HIV test. Because affordable treatment is now available, it is possible to implement on a much greater scale programs of prevention of mother-to-child HIV transmission, accompanied by the expansion of prenatal HIV testing. It is therefore important to understand the reasons women refuse these tests. Here we analyse the women who refused the offer of prenatal HIV testing in the DITRAME Plus research program, intended to prevent mother-to-child transmission in Abidjan from 2001 through 2005. Three groups of women were followed for two years after they were offered HIV counselling and testing during an antenatal consultation: 347 HIV-infected women, 393 seronegative women, and 62 women who refused HIV testing. Nine months after delivery, HIV testing was again offered to the latter group. We collected quantitative data on social and demographic characteristics, sexual behavior, and communication with their male partners about STIs, HIV, and HIV testing, before and after the pregnancy. In-depth interviews were conducted with 15 women who refused HIV-testing. We sought to determine if their sociodemographic and behavioural profile was closer to that of HIV-positive or seronegative women, to assess the effects of prenatal counselling and the offer of testing on their attitudes about HIV risk, and to measure the percentage of women who accepted testing when the offer was repeated 9 months postpartum. Women who refused HIV-testing had a sociodemographic profile similar to that of the women who accepted testing and were seronegative. They did not have more at-risk behaviours. These women offered several reasons for their refusal, including avoidance of the anguish of a positive test result and the desire to ask their husbands first. Among the women who initially refused prenatal testing, only 23% had discussed STI/HIV issues with their male partner; after the testing offer, more than 90% suggested that their partner have an HIV test. Finally, 20% accepted the postpartum test offer, and those whose male partner had an HIV test were four times more likely than the others to accept (RR = 4.05 [1.55-10.58]). This study shows that prenatal counselling and the offer of HIV testing have beneficial effects on HIV prevention within the couple, even for women who refuse testing. It also points out that the decision to accept testing may take time and that repeating the offer is worthwhile. Finally, our results confirm the importance of the role of the regular partner in the acceptance of HIV testing, and reinforce the relevance of a couple-centred approach to voluntary counselling and testing.

Increased Uptake of HIV Testing With the Integration of Nurse-Initiated HIV Testing Into Routine Prenatal Care

Increased Uptake of HIV Testing With the Integration of Nurse-Initiated HIV Testing Into Routine Prenatal Care

Implementação do diagnóstico da infecção pelo HIV para gestantes em Unidade Básica de Saúde da Família em Fortaleza, Ceará

Free access to prenatal care and HIV tests represent the first step in the prevention of vertical transmission and guarantees early prophylactic measures. This study aims at analyzing the coverage of HIV testing in pregnant women in a Basic Family Health Unit in the city of Fortaleza, Ceará. The theoretical-methodological basis of the study was the grounded theory, which proposes generation of theory from data derived from the social reality. Data were collected through participant observation, open interviews with physicians, nurses and pregnant women and in focal groups with pregnant women and health agents. The women faced institutional barriers to prenatal care and HIV testing. Difficulties in making the appointments for prenatal care hampered early identification of pregnant women and delayed their assistance. With respect to HIV testing, the study found that the Basic Health Unit does not collect the biologic material; there are few laboratories performing this kind of exam and those who do are very far from the pregnant women's residences. This study concludes that even in the Family Health Unit, the access to prenatal care for pregnant women remains difficult, and that the prevention of vertical HIV transmission depends on political, institutional and structural changes.

The involvement of men within prenatal HIV counselling and testing. Facts, constraints and hopes

The involvement of men within prenatal HIV counselling and testing. Facts, constraints and hopes

Analysis of theory utilization among prenatal HIV-testing research.

To ascertain extent and quality of theory utilization among published empirical studies specific to prenatal HIV testing. Systematic literature search for peer-reviewed articles was performed. Articles with "perceived barriers" construct to prenatal HIV testing from perspective of potential testees were sought. Most studies mention constructs, but not specific theory. Few studies clearly reported how operationalized constructs were used within their studies. Paucity of theory utilization points to a breach of the "science" in the scientific process. Researchers either failed to adequately use theory or did so but failed to describe how.

Attitudes About Prenatal Hiv Testing in Turkey

The aim of this study was to assess the attitudes of Turkish pregnant women and antenatal health care providers towards prenatal HIV testing. A self-administered questionnaire was used. The relationships between the different groups' knowledge and attitudes were analysed by using the chi-squared statistic. A total of 494 pregnant women and 181 care providers participated. Forty-four per cent of the pregnant women thought that prenatal HIV testing should be mandatory, and 84% of the health care providers thought it should be performed routinely or be mandatory. The majority of the pregnant women (74%) and half of the care providers agreed that the test results should be disclosed first to the pregnant woman. The study results also revealed that most of the prenatal care providers would not protect pregnant women's autonomy and privacy, contrary to the pregnant women's own preferences. It is essential to establish national prenatal HIV testing policies in order to prevent unethical practices and ensure satisfaction for pregnant women and health care providers.

HIV Seroprevalence among Women Opting Out of Prenatal HIV Screening in Alberta, Canada: 2002-2004

Alberta, Canada, uses an "opt-out" strategy for prenatal HIV testing. We examined demographic characteristics of and HIV seroprevalence among women opting out. The proportion of total specimens that were from women who opted out decreased from 4.3% in 2002 to 3.6% in 2004 (P<.001), and HIV seroprevalence among these specimens was 0.07%, which was 3.3 times higher than the HIV seroprevalence among specimens from women who opted in. Women opting out may have a higher HIV infection risk.