“I have never heard them say, ‘For those women who were already tested, they should go for blood testing again." Prevalence and factors associated with uptake of repeat HIV testing among pregnant women in Blantyre, Malawi

Abstract

Repeat HIV testing during pregnancy is significant to detect new maternal HIV infections and mitigate the risk of mother-to-child HIV transmission. Despite guidelines advocating retesting of initially HIV-negative pregnant women, there is limited information on the implementation of these recommendations. Methods We conducted a convergent parallel mixed method study from November 2021 to April 2022 to determine the prevalence and associated factors for a repeat HIV test among women in the third trimester from Ndirande and Lirangwe primary health facilities in Blantyre. Our quantitative approach involved a retrospective review of antenatal records from July 2019 to June 2020. STATA version 14 was used for descriptive analysis. Frequency distributions, fisher’s tests and multivariable logistic regressions were used to examine the association between repeat HIV testing and selected explanatory variables. The qualitative component was exploratory following phenomenological design. Data were collected from 44 pregnant women and 10 health workers who were purposively selected through focus group discussions in-depth and key informant interviews. Transcripts were coded deductively and inductively manually. The thematic analysis of the data was informed by the Consolidated Framework for Implementation Research (CFIR). Results Analysis of 369 antenatal records, with 302 from Ndirande and 67 from Lirangwe, revealed that only 30 (8.13%) participants received a repeat HIV test in the third trimester from both facilities. Increasing age reduced the likelihood of accessing repeat HIV testing in the third trimester compared to younger women (OR = 0.43; 95% CI: 0.05–3.86). Age, gravidity, and parity did not significantly impact the probability of retesting. Key factors impeding repeat HIV testing included unfamiliarity with the intervention, inadequate resources and clinic operations. In contrast, confirmation of HIV status and improved neonatal outcomes were motivators for repeat HIV testing. Conclusion. Information and counselling on the benefits of repeat HIV testing later in pregnancy is key in increasing uptake and implementation of the service in future pregnancies. In addition, integration of services should be emphasized to improve clinic operations which are vital in the implementation and uptake of repeat HIV testing among pregnant women.