High rates of HIV seroconversion in pregnant women and low reported levels of HIV testing among male partners in southern Mozambique: Results from a mixed methods study

Introduction Prevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV. Identification and support for HIV negative pregnant women and their partners, particularly serodiscordant couples, are critical. A mixed method study done in Southern Mozambique estimated HIV incidence during pregnancy, associated risk factors and factors influencing partner\u27s HIV testing. Methods Between April 2008 and November 2011, a prospective cohort of 1230 HIV negative pregnant women was followed during pregnancy. A structured questionnaire, HIV testing, and collection of dried blood spots were done at 2–3 scheduled visits. HIV incidence rates were calculated by repeat HIV testing and risk factors assessed by Poisson regression. A qualitative study including 37 individual interviews with men, women, and nurses and 11 focus group discussions (n = 94) with men, women and grandmothers explored motivators and barriers to uptake of male HIV testing. Results HIV incidence rate was estimated at 4.28/100 women-years (95%CI: 2.33–7.16). Significant risk factors for HIV acquisition were early sexual debut (RR 3.79, 95%CI: 1.04–13.78, p = 0.04) and living in Maputo Province (RR 4.35, 95%CI: 0.97–19.45, p = 0.05). Nineteen percent of women reported that their partner had tested for HIV (93% knew the result with 8/213 indicating an HIV positive partner), 56% said their partner had not tested and 19% did not know their partner test status. Of the 14 seroconversions, only one reported being in a serodiscordant relationship. Fear of discrimination or stigma was reported as a key barrier to male HIV testing, while knowing the importance of getting tested and receiving care was the main motivator. Conclusions HIV incidence during pregnancy is high in Southern Mozambique, but knowledge of partners\u27 HIV status remains low. Knowledge of both partners\u27 HIV status is critical for maximal effectiveness of prevention and treatment services to reach elimination of pediatric HIV/AIDS

High rates of HIV seroconversion in pregnant women and low reported levels of HIV testing among male partners in Southern Mozambique: results from a mixed methods study.

INTRODUCTION: Prevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV. Identification and support for HIV negative pregnant women and their partners, particularly serodiscordant couples, are critical. A mixed method study done in Southern Mozambique estimated HIV incidence during pregnancy, associated risk factors and factors influencing partner's HIV testing. METHODS: Between April 2008 and November 2011, a prospective cohort of 1230 HIV negative pregnant women was followed during pregnancy. A structured questionnaire, HIV testing, and collection of dried blood spots were done at 2-3 scheduled visits. HIV incidence rates were calculated by repeat HIV testing and risk factors assessed by Poisson regression. A qualitative study including 37 individual interviews with men, women, and nurses and 11 focus group discussions (n = 94) with men, women and grandmothers explored motivators and barriers to uptake of male HIV testing. RESULTS: HIV incidence rate was estimated at 4.28/100 women-years (95%CI: 2.33-7.16). Significant risk factors for HIV acquisition were early sexual debut (RR 3.79, 95%CI: 1.04-13.78, p = 0.04) and living in Maputo Province (RR 4.35, 95%CI: 0.97-19.45, p = 0.05). Nineteen percent of women reported that their partner had tested for HIV (93% knew the result with 8/213 indicating an HIV positive partner), 56% said their partner had not tested and 19% did not know their partner test status. Of the 14 seroconversions, only one reported being in a serodiscordant relationship. Fear of discrimination or stigma was reported as a key barrier to male HIV testing, while knowing the importance of getting tested and receiving care was the main motivator. CONCLUSIONS: HIV incidence during pregnancy is high in Southern Mozambique, but knowledge of partners' HIV status remains low. Knowledge of both partners' HIV status is critical for maximal effectiveness of prevention and treatment services to reach elimination of pediatric HIV/AIDS

Summary of barriers, motivators of accessing HIV testing by male partners.

<p><i>MCH – Mother and Child Health.</i></p><p>Summary of barriers, motivators of accessing HIV testing by male partners.</p

Baseline characteristics of the study population (n = 1230).

<p>Baseline characteristics of the study population (n = 1230).</p

Flowchart of the cohort study.

<p>Study visits were scheduled at enrollment, 28 weeks of gestational age (visit 2), and delivery (visit 3). Women enrolled at gestational age <28 weeks (n = 855) had three scheduled visits. Women who enrolled between 28 and 32 weeks of gestational age (n = 360) participated in only two of the three study visits (enrollment visit and delivery). Fifteen women enrolled at a gestational age between 0–32 weeks, but exact age was not known. SC seroconversion; HIV – HIV negative; LFU lost to follow-up.</p

Characteristics of participants of the qualitative study (n = 118).

<p>Characteristics of participants of the qualitative study (n = 118).</p

Risk ratios for socio-demographic, sexual behavior and knowledge risk factors among women with follow-up (n = 968).

<p>SC =  seroconversion; VT =  vertical transmission.</p>1<p>p-values from bivariable Poisson regression models (i.e., generalized linear models using the Poisson distribution with the log link and an offset accounting for person-years).</p>2<p>Risk ratio for a age compares two groups that differ by one year.</p><p>Boldface  =  statistically significant (p<0.05).</p><p>Risk ratios for socio-demographic, sexual behavior and knowledge risk factors among women with follow-up (n = 968).</p