Date Published: December , 2017
Publisher: Makerere Medical School
Author(s): Emily C Namara-Lugolobi, Gertrude Nakigozi, Zikulah Namukwaya, Dan K Kaye, Edith Nakku-Joloba.
Knowledge of a person’s HIV status during pregnancy is critical for prevention of mother to child transmission of HIV.
To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital.
This was a cross-sectional study of women that had just delivered. The women’s demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher’s exact test, Wilcoxon rank sum test and logistic regression were used to test associations.
The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 – 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 – 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/government accredited health facilities “opted out” of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one “opted out”.
Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC.
Mother to Child transmission (MTCT) of HIV accounts for more than 90% of all new paediatric HIV infections and occurs in utero, during labour and delivery and during breastfeeding1. Without any intervention, the MTCT rate ranges from 15% to 45%2. The use of anti-retroviral therapy (ART) and elective caesarean section has reduced MTCT rates to less than 2% in non-breastfeeding populations2. Even in breastfeeding populations, studies have demonstrated that timely anti-retroviral drugs can reduce mother to child transmission of HIV to 5% or less3–5.
This was a cross-sectional study on women who had just delivered and were admitted on the post-natal ward in Mulago Hospital.
Participants’ median age was 24 years with the interquartile range of 21 to 28 years. About 40% were delivering for the first time (prime-parous), 47.9% were giving birth for the second to fourth time while only 10% were delivering for more than the fourth time (multi-parous). The majority were married (84%) and 78% of the married women were in monogamous relationships. About 62% had attained an education level of secondary education or higher, while 6.6% had no formal education.
The above results show that uptake of HIV testing during ANC among women delivering in Mulago Hospital is almost 100%. Nevertheless, a few women (2.6%) presented in labour with unknown HIV status. The prevalence of unknown HIV status at labour increased from 2.6% to 7.9% when participants who reported in labour without evidence of testing for HIV are considered as having unknown HIV status, a criterion that was used by Ononge etal13 in 2006. In practice, evidence of HIV testing is critical to determine intervention to prevent mother to child transmission of HIV. However, lack of documentation by health workers, loss of documents and forgetting to bring documents to hospital in view of the unpredictable timing of labour can cause women to report without evidence of HIV testing. Indeed, studies have reported knowledge of HIV status to be the commonest reason for refusal to test for HIV at labour and delivery despite this being undocumented15,16.