Uptake Of Repeat HIV Testing During Pregnancy, Labour And Post Natal Period Following An Initial Negative Result In Pregnancy In Kisumu County

Abstract

Background: Young women represent the population with the fastest increase in HIV infection, with more than 60% of all new infections occurring in them with Mother to child transmission (MTCT) responsible for over 90% of pediatric HIV (3,4). Over the years, significant gains have been made in the PMTCT, with reduction in rates to less than 6% and a reduction in levels of transmission of new infections by 50% (4, 5). Repeat HIV testing in late pregnancy has the potential to reduce MTCT rates by identifying mothers who seroconvert after having tested negative for HIV earlier in pregnancy (8, 9) and this strategy is now incorporated into the Kenya PMTCT program. Currently there is little evidence to the uptake of the guidelines on repeat testing during the pregnancy and immediate post-partum period. Objective: The aim of the study was to determine the uptake of repeat HIV testing services after an initial negative result in pregnancy, labor and the 6 weeks’ post-natal period in Kisumu County and to identify the barriers to uptake of the HIV retesting guidelines. Methodology: A combined quantitative and qualitative aspects was utilized: a cross sectional among women who had tested HIV negative at the initial ANC visit and were attending the 6week immunization clinic were consecutively sampled, and after obtaining informed consent, were interviewed using a standard tool to collect information on social demographic characteristics and whether they had accessed a repeat HIV test. Secondary and a qualitative aspect that involved focus group discussion with the healthcare workers at the MCH clinic and key informant interview with the clinic heads and program directors. Data was then entered and analyzed using SPSS for any associations and correlations. Qualitative data was recorded and analyzed using qualitative tools SDQ. Results: 380 mothers attending MCH clinic for routine child immunization at 3 health facilities in Kisumu County were interviewed. The median age was 25 [IQR 21-31] with majority of the women having had at least some form of education. Almost two thirds of the women 243 (64.3%) were married, however of these 22.3%had their husbands staying away from home and only 47.3%were aware of the HIV status of their partners. Most women 372 (97.9%) had a HIV x test done during their first visit at the ANC which happened on average at 7 months of pregnancy. The retesting rate was 68.4 %(p<0.0001) and the factors that were significant in determining retesting rate after multivariate analysis included the age of the mother and the time of initiation of the first ANC visit. Women who attended ANC earlier were more likely to accept repeat HIV testing than those who came later (6.3 weeks vs 11.7 weeks, p<0.0001). Older women were likely to take up repeat testing (OR 0.9 [95% CI of OR0.8 - 0.9], p=0.046). In the qualitative arm of the study across the three facilities, the age of the mother and the time of initiating ANC visits were among the patient factors that were important in determining the uptake of the repeat testing services and thus was collaborative with the quantitative study. Conclusion; According to our study Initial HIV testing rates were high at 97.4%, mothers were willing to have repeat tests done. Awareness of the need to have repeat HIV testing affected the retesting rates. The average retesting rate was higher than the National rates at 68.4%. Independent predictors of up-take of re-testing was older age, and earlier initiation of antenatal care. Recommendations: Increase awareness on the need to have HIV testing and emphasis to be made on repeat HIV testing. Trainings and Continuous Education on key areas like PMTCT. Government involvement of Counties in the implementation of national guidelines.