Tropical Medicine and International Health
doi:10.1111/tmi.12432
volume 20 no 3 pp 277–283 march 2015
Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia Steffie Heemelaar1,*, Nicole Habets1,*, Ziche Makukula1, Jos van Roosmalen2,3 and Thomas van den Akker2 1 Department of Obstetrics, Saint Francis Hospital, Katete, Zambia 2 Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands 3 VU Medical Centre, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
Abstract
objective To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. methods A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form. results Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery. conclusion Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. keywords HIV, quality of care, pregnancy, prenatal care, maternal and child health
Introduction Almost 260 000 infants were newly infected with HIV in 2012 of whom more than 90% live in sub-Saharan Africa (UNAIDS 2013). In the absence of any intervention, mother-to-child transmission (MTCT) rates range from 15% in non-breastfeeding populations up to 45% after 24 months of breastfeeding (De Cock et al. 2000). With successful implementation of the WHO guidelines, it is estimated that the risk of MTCT can be reduced to
doi:10.1111/tmi.12432
volume 20 no 3 pp 277–283 march 2015
Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia Steffie Heemelaar1,*, Nicole Habets1,*, Ziche Makukula1, Jos van Roosmalen2,3 and Thomas van den Akker2 1 Department of Obstetrics, Saint Francis Hospital, Katete, Zambia 2 Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands 3 VU Medical Centre, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
Abstract
objective To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. methods A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form. results Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery. conclusion Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. keywords HIV, quality of care, pregnancy, prenatal care, maternal and child health
Introduction Almost 260 000 infants were newly infected with HIV in 2012 of whom more than 90% live in sub-Saharan Africa (UNAIDS 2013). In the absence of any intervention, mother-to-child transmission (MTCT) rates range from 15% in non-breastfeeding populations up to 45% after 24 months of breastfeeding (De Cock et al. 2000). With successful implementation of the WHO guidelines, it is estimated that the risk of MTCT can be reduced to
