TY - JOUR
T1 - Missed opportunities
T2 - Barriers to hiv testing during pregnancy from a population based cohort study in rural uganda
AU - Larsson, Elin C.
AU - Thorson, Anna Ekéus
AU - Pariyo, George
AU - Waiswa, Peter
AU - Kadobera, Daniel
AU - Marrone, Gaetano
AU - Ekström, Anna Mia
N1 - Funding Information:
The opt-out testing policy seems to work fairly well in facilities where HIV testing is available onsite since 85% of the women who attended such facilities were tested. This finding is also supported by previous research . However, very few women, only 6% who attended ANC at health facilities without testing onsite, were referred or carried out referral for testing. Moreover, only 20% of the women seeking ANC at facilities without testing had been counseled about or counseled and tested for HIV; and yet, the Ugandan PMTCT guidelines state that all pregnant women should be counseled . This finding is consistent with a recent qualitative study conducted from the same area which suggested inadequate HIV counseling and a lack of testing referral from this type of facility . Our analysis further reports that male partner support was low, only 13% of the pregnant women reported being accompanied to the ANC facility by their spouse, and 4% of the women had had couple HIV testing.
PY - 2012/8/16
Y1 - 2012/8/16
N2 - 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.
AB - 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.
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U2 - 10.1371/journal.pone.0037590
DO - 10.1371/journal.pone.0037590
M3 - Article
C2 - 22916089
AN - SCOPUS:84865066022
SN - 1932-6203
VL - 7
JO - PloS one
JF - PloS one
IS - 8
M1 - e37590
ER -