Serial HIV Testing

Acceptability and feasibility of serial HIV testing during pregnancy and the postpartum period with male partner testing in Tororo, Uganda

PIs: Lena H. Kim, MD and Pius Okong, MBChB, Dip Obs, MMed, PhD Co-investigators: Emmanuel Arinaitwe, MBChB; Bridget Nzarubara, MBChB; Moses R. Kamya, MBChB, MMed, MPH; Tamara D. Clark, MHS; Edwin D. Charlebois, PhD, MPH; Diane V. Havlir, MD; and Deborah Cohan, MD, MPH

This was an NIH funded (P30-AI027763) prospective cohort study at the Tororo District Hospital Antenatal Clinic.

Recognizing that perinatal transmission of HIV continues to be a critical public health crisis, the Joint United Nations Programme on HIV/AIDS (UNAIDS) declared a country-led multinational goal to eliminate perinatal HIV infections and to improve maternal HIV care by 2015. One-time testing fails to diagnosis incident HIV infection later in pregnancy or while breastfeeding. Therefore serial HIV testing during both pregnancy and the postpartum period to detect incident HIV infection could be a critical step forward as part of the UNAIDS global initiative to eliminate transmission to children. In order to assess the acceptability and feasibility of serial HIV testing, HIV-negative pregnant women were asked to participate in repeat HIV tests integrated into routine follow up antenatal and postpartum child immunization visits. Serial testing was defined as ≥2 tests during pregnancy and ≥2 tests within 24 weeks postpartum. Participants were also asked to invite their male partner for HIV testing at any point during the study period. Eighty women (37%) completed serial testing, 176 (82%) had ≥2 tests and 147 (69%) had ≥3 tests during the study period. One hundred and eight-two women (85%) accepted male partner testing, but only 19 men (10%) participated. One woman seroconverted during the study, for a cumulative HIV incidence of 0.5% (1/214). In multivariable logistic regression analysis, longer distance between home and clinic (aOR 0.87 [95% CI 0.79-0.97]) and not knowing household income (aOR 0.30 [95% CI 0.11-0.84]), were predictive of not completing serial testing. Higher level of education was associated with completing serial testing (linear trend p value = 0.05). Overall, the integration of a serial HIV testing program into routine antenatal and postnatal health care visits was highly acceptable to pregnant women in this resource poor area of sub-Saharan Africa. The majority of women completed at least 2 HIV tests during the study period. However, since only 37% of women completed serial HIV testing, a less intensive serial HIV testing protocol consisting of one repeat test in the 3rd trimester of pregnancy and 1 repeat HIV test at 6 months postpartum may be more feasible. While women reported high interest in involving their male partners in HIV testing and testing was offered free of charge, actual uptake of HIV testing among men was very low. Innovative strategies to successfully integrate male partner testing within routine antenatal and postpartum health services as part of a comprehensive HIV prevention program in sub-Saharan Africa needs to be piloted and studied.