HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia

  • PLoS ONE, Volume 13, No. 8, Year 2018

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Study Justification:
– HIV testing during pregnancy is crucial for preventing mother-to-child transmission of HIV and accessing treatment for HIV-positive women.
– The study aimed to assess the uptake of HIV testing during pregnancy and identify factors associated with it among Ethiopian women.
– Understanding the current situation and factors influencing HIV testing during pregnancy can help inform interventions and improve uptake.
Highlights:
– Only 35.1% of women in Ethiopia were tested for HIV and received the test results during pregnancy.
– One-third of women who had antenatal care missed the opportunity to be tested for HIV.
– Women with higher education, awareness of mother-to-child transmission of HIV, and living in urban areas were more likely to be tested for HIV during pregnancy.
– Women with stigmatizing attitudes towards HIV-positive people were less likely to be tested for HIV.
Recommendations:
– Integrate HIV testing with antenatal care services to increase uptake.
– Improve the quality and access to HIV testing services during pregnancy.
– Increase awareness about mother-to-child transmission of HIV.
– Address stigmatizing attitudes towards HIV-positive people.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation of HIV testing programs during pregnancy.
– Healthcare Providers: Involved in providing HIV testing services and counseling during antenatal care visits.
– Community Health Workers: Play a role in raising awareness about HIV testing during pregnancy and addressing stigmatizing attitudes.
– Non-Governmental Organizations: Support implementation of HIV testing programs and provide resources for testing services.
Cost Items for Planning Recommendations:
– Training and Capacity Building: Budget for training healthcare providers and community health workers on HIV testing and counseling.
– Infrastructure and Equipment: Allocate funds for setting up and maintaining HIV testing facilities, including laboratory equipment and supplies.
– Awareness Campaigns: Budget for public awareness campaigns to promote HIV testing during pregnancy and reduce stigma.
– Monitoring and Evaluation: Allocate resources for monitoring and evaluating the implementation and impact of HIV testing programs.
Please note that the cost items provided are general categories and not actual cost estimates. The specific budget requirements will depend on the context and scale of implementation.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study utilized a large dataset from the 2016 Ethiopian Demographic and Health Survey, which enhances the generalizability of the findings. The study also employed a stratified, two-stage cluster sampling technique to ensure representativeness. The statistical analysis included adjusted odds ratios and 95% confidence intervals, which adds to the robustness of the results. However, the abstract could be improved by providing more information on the sample size and response rate, as well as the specific methods used for data collection and analysis. Additionally, it would be helpful to include information on any limitations of the study and suggestions for future research. Overall, the evidence is fairly strong, but these suggested improvements would enhance the clarity and completeness of the abstract.

Introduction HIV testing during pregnancy provides an entry point to prevention of mother-to-child transmission of HIV and to access treatment for HIV positive women. The study aimed to assess the uptake of HIV testing during pregnancy and associated factors among Ethiopian women. Methods We analyzed the 2016 Ethiopian Demographic and Health Survey dataset. Women who gave birth within one year prior to the survey were included in the analysis. Uptake of HIV testing during pregnancy is defined as receiving HIV testing service during pregnancy and/ or at the time of delivery and knew the test results. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated by using step-wise backward logistic regression analyses to identify factors associated with HIV testing during pregnancy. Results A total of 2114 women who were pregnant in the last one year prior to the survey were included in the analysis. Of these, only 35.1% were tested for HIV and received the test results during pregnancy. About one third of women who had antenatal care follow-up missed the opportunity to be tested for HIV. Compared to women who had no formal education, those who had primary level education (AOR = 1.55; 95% CI: 1.12–2.15), secondary level education (AOR = 2.56 95%CI: 1.36–3.82), or higher education (AOR = 3.95, 95%CI: 1.31–11.95) were more likely to be tested for HIV during pregnancy. Similarly, having awareness about mother-to-child transmission of HIV (AOR = 2.03, 95%CI: 1.48–2.78), and living in urban areas (AOR = 3.30, 95%CI: 1.39–7.85) were positively and independently associated with uptake of HIV during pregnancy. Women who have stigmatizing attitude towards HIV positive people were less likely to be tested for HIV (AOR = 0.57, 95%CI: 0.40–0.79). Conclusion Uptake of HIV testing during pregnancy is low. Missed opportunity among women who had antenatal care visits was very high. Integrating HIV testing with antenatal care services, improving HIV testing service quality and access are essential to increase uptake of HIV testing during pregnancy and reach the goal of eliminating MTCT.

We used data from the EDHS 2016 survey. The survey was conducted between January 18, 2016 and June 27, 2016. It covered all nine regions and two city administrations of Ethiopia. The survey was designed to be representative of the country and each region by taking a sampling frame from the 2007 population census of Ethiopia. The current study focuses on analyzing coverage of HIV counseling and testing service during pregnancy with a primary purpose of preventing mother-to-child transmission of HIV. The survey employed a stratified, two-stage cluster sampling technique. Ethiopia has nine administrative regions and two city administrations. The regions are divided in to zones, districts and kebeles (the lowest administrative units). A total of 84,915 census enumeration areas (EAs) were created by dividing kebeles with an average of 181 households per EA. Samples of 645 EAs (202 from urban and 443 from rural areas) were randomly selected, and 28 households from each EA were included in the survey by applying a systematic random sampling strategy. The survey administered questionnaires and collected biological sample from women of reproductive age group (15 to 49 years), children under five years old and men age between 15 to 59 years. However, for this particular study, women of reproductive age group were the source population, and women who gave birth to their last child in the last one year prior to the survey were the study populations (we restricted the sample to birth in the last one year so as to minimize recall bias).We used data collected from women of reproductive age group (15–49 years) using DHS’s women’s questionnaire [21], The questionnaire was a standardized and field tested tool used in different countries and only a subset of variables were included in the current study. Data quality was preserved by pre-testing the survey tools preceding the survey, and data were collected by trained survey teams consisted of one team supervisor, one field editor, four female interviewers, and two male interviewers. In addition, independent quality control team was used to check the quality of the collected data. The outcome variable is uptake of HIV testing during pregnancy (yes or no). Uptake HIV testing during pregnancy is defined as receiving HIV testing service during pregnancy and/or at the time of delivery and knew the test results. We included potential predictors of HIV counseling and testing, such as maternal age in years, marital status (never married, married and divorced/widowed/separated), religion (Orthodox, Muslim, Protestant and Others), region, residence (urban and rural), educational status (no education, primary, secondary, and higher), wealth index (poorest, poorer, middle, richer, and richest), and awareness of MTCT of HIV was defined as awareness of women about possibility of HIV transmission from HIV positive mother to a child (yes or no). Employment status was defined as having any kind of job other than their housework in the last 12 months before the survey (not employed, or employed). Finally, stigmatizing attitude towards HIV positive people was measured by respondents’ refusal to buy vegetable form known HIV positive vendor (yes or no). The survey employed a stratified two stage sampling and there was over sampling of some populations, as a result complex survey data analysis and weighting were employed as recommended by DHS [22], to make the data more representative of the national population and all the findings are based on weighted analysis. Descriptive statistics were computed to summarize socio-demographic characteristics of study participants. We compared the socio demographic characteristics of women who had HIV testing during their last pregnancy with those who were not tested for HIV using weighted chi-square tests. Moreover, we run a weighted bivariate and multivariate logistic regression analysis, reporting odds ratio (OR) and 95% confidence interval (CI). The multivariate logistic regression analysis was conducted by using step-wise backward elimination technique after including all relevant covariates in the model and eliminating one variable at a time. Variables which had P values <0.05 were considered significant. Data analysis was carried out by STATA version 14 (Stata Corp., College Station, TX). The study was approved by the Federal Democratic Republic of Ethiopia Ministry of Science and Technology and the Institutional Review Board of ICF International. Moreover, the respondents gave written consent to participate in the survey. Data collectors were trained for one month on different aspects of the data collection process, including ethical issues.

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Based on the information provided, here are some potential innovations that could improve access to maternal health, specifically in relation to HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia:

1. Integrated Antenatal Care Services: Integrating HIV testing with antenatal care services can help ensure that all pregnant women have access to HIV testing during pregnancy. This could involve training healthcare providers to offer HIV testing as a routine part of antenatal care visits.

2. Mobile Health (mHealth) Solutions: Utilizing mobile health technologies, such as SMS reminders and appointment scheduling, can help improve access to HIV testing during pregnancy. Sending reminders to pregnant women about the importance of HIV testing and providing information on where and when to get tested can increase uptake.

3. Community-Based Education and Awareness Programs: Implementing community-based education and awareness programs can help increase knowledge and awareness about mother-to-child transmission of HIV. These programs can target both pregnant women and their communities, providing information on the benefits of HIV testing during pregnancy and addressing any stigmatizing attitudes towards HIV positive people.

4. Improving Access to Testing Services: Ensuring that HIV testing services are readily available and accessible to pregnant women is crucial. This could involve expanding the number of testing sites, particularly in rural areas, and extending testing hours to accommodate women’s schedules.

5. Quality Improvement Initiatives: Implementing quality improvement initiatives can help improve the overall quality of HIV testing services during pregnancy. This could involve training healthcare providers on best practices for HIV testing, ensuring the availability of necessary testing supplies, and conducting regular monitoring and evaluation to identify areas for improvement.

These innovations aim to address the low uptake of HIV testing during pregnancy in Ethiopia and improve access to maternal health services for pregnant women.
AI Innovations Description
Based on the information provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Integrating HIV testing with antenatal care services: One of the key findings from the study is that there is a missed opportunity for HIV testing among women who had antenatal care visits. To address this, an innovation could be developed to integrate HIV testing with antenatal care services. This could involve training healthcare providers to offer HIV testing as a routine part of antenatal care visits, ensuring that every pregnant woman is offered the test and receives the results. This integration would help increase the uptake of HIV testing during pregnancy and improve access to prevention of mother-to-child transmission of HIV.

Additionally, here are some other potential innovations that could be considered:

1. Mobile HIV testing units: In areas where access to healthcare facilities is limited, mobile units equipped with HIV testing facilities could be deployed to reach pregnant women in remote or underserved areas. These units could travel to different locations, providing convenient and accessible testing services during pregnancy.

2. Community-based HIV testing campaigns: Engaging community health workers and volunteers to conduct HIV testing campaigns in local communities could help raise awareness about the importance of testing during pregnancy and encourage more women to get tested. These campaigns could include educational sessions, counseling, and on-site testing services.

3. Telemedicine and remote counseling: Utilizing telemedicine technology, pregnant women in remote areas could have access to counseling and support from healthcare professionals. This could help address any concerns or misconceptions about HIV testing and encourage more women to seek testing services.

4. Improving HIV testing service quality: Ensuring that HIV testing services are of high quality and meet international standards is crucial. This could involve training healthcare providers on best practices for HIV testing, ensuring the availability of accurate and reliable testing kits, and implementing quality assurance measures to monitor and evaluate the performance of testing services.

By implementing these recommendations and innovations, access to maternal health, specifically HIV testing during pregnancy, can be improved, leading to better prevention of mother-to-child transmission of HIV and improved health outcomes for both mothers and children.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health, specifically related to HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia:

1. Integration of HIV testing with antenatal care services: Strengthen the integration of HIV testing services into routine antenatal care visits. This can be achieved by training healthcare providers to offer HIV testing as a standard part of antenatal care and ensuring that testing services are readily available at healthcare facilities.

2. Improving HIV testing service quality: Enhance the quality of HIV testing services by ensuring that healthcare providers are trained on the latest testing techniques and protocols. This includes providing regular refresher training to healthcare providers to keep them updated on best practices in HIV testing.

3. Increasing awareness about mother-to-child transmission of HIV: Implement targeted awareness campaigns to educate pregnant women and their families about the risks of mother-to-child transmission of HIV and the importance of HIV testing during pregnancy. This can be done through community outreach programs, mass media campaigns, and educational materials distributed at healthcare facilities.

4. Addressing stigmatization: Develop strategies to address stigmatization towards HIV positive people, as this can act as a barrier to HIV testing during pregnancy. This can involve community sensitization programs to reduce stigma and discrimination, as well as promoting a supportive and non-judgmental environment for pregnant women seeking HIV testing services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the percentage of pregnant women tested for HIV during pregnancy, the percentage of women who received their test results, and the percentage of women who were aware of mother-to-child transmission of HIV.

2. Collect baseline data: Gather baseline data on the selected indicators from a representative sample of pregnant women in Ethiopia. This can be done through surveys or by analyzing existing data sources, such as the Ethiopian Demographic and Health Survey.

3. Implement the recommendations: Implement the recommended interventions, such as integrating HIV testing with antenatal care services, improving service quality, increasing awareness, and addressing stigmatization.

4. Monitor and evaluate: Continuously monitor the implementation of the recommendations and collect data on the selected indicators. This can be done through regular surveys or by analyzing routine data collected at healthcare facilities.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations on the selected indicators. This can involve comparing the baseline data with the post-intervention data to determine any changes in access to maternal health.

6. Interpret the results: Interpret the findings to understand the effectiveness of the recommendations in improving access to maternal health. This can involve calculating the percentage change in the selected indicators and identifying any significant associations between the interventions and the outcomes.

7. Adjust and refine: Based on the results, make any necessary adjustments or refinements to the recommendations to further improve access to maternal health. This can involve scaling up successful interventions, addressing any challenges or barriers identified during the evaluation, and continuously monitoring and evaluating the impact of the interventions over time.


Statistics:
Citations: 28
Identifiers:
DOI: 10.1371/journal.pone.0201886
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Technology and Innovations
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cohort Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
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