Temporal Trends and Determinants of HIV Testing at Antenatal Care in Sub-Saharan Africa: A Pooled Analysis of Population-Based Surveys (2005–2021)

Author:

Allorant Adrien1,Muset Paul1,Hodgins Caroline1,Kirakoya-Samadoulougou Fati2,Namachapa Khumbo3,Mbofana Francisco4,Panagiotoglou Dimitra1,Johnson Leigh F.5,Imai-Eaton Jeffrey W.67,Maheu-Giroux Mathieu1ORCID

Affiliation:

1. Department of Epidemiology and Biostatistics, School of Global and Population Health, McGill University, Montréal, Canada;

2. Research Center in Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium;

3. Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi;

4. Conselho Nacional de Combate ao SIDA, Ministry of Health, Maputo, Mozambique;

5. Centre for Infectious Disease Epidemiology and Research, University of Cape Town, City of Cape Town, WC, South Africa;

6. Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA; and

7. MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.

Abstract

Background: In sub-Saharan Africa (SSA), integrating HIV testing into antenatal care (ANC) has been crucial toward reducing mother-to-child transmission of HIV. With the introduction of new testing modalities, we explored temporal trends in HIV testing within and outside of ANC and identified sociodemographic determinants of testing during ANC. Methods: We analyzed data from 139 nationally representative household surveys conducted between 2005 and 2021, including more than 2.2 million women aged 15–49 years in 41 SSA countries. We extracted data on women's recent HIV testing history (<24 months), by modality (ie, at ANC versus outside of ANC) and sociodemographic variables (ie, age, socioeconomic status, education level, number of births, urban/rural). We used Bayesian generalized linear mixed models to estimate HIV testing coverage and the proportion of those that tested as part of ANC. Results: HIV testing coverage (<24 months) increased substantially between 2005 and 2021 from 8% to 38%, with significant variations between countries and subregions. Two percent of women received an HIV test in the 24 months preceding the survey interview as part of ANC in 2005 and 11% in 2021. Among women who received an HIV test in the 24 months preceding the survey, the probability of testing at ANC was significantly greater for multiparous, adolescent girls, rural women, women in the poorest wealth quintile, and women in West and Central Africa. Conclusion: ANC testing remains an important component to achieving high levels of HIV testing coverage and benefits otherwise underserved women, which could prove instrumental to progress toward universal knowledge of HIV status in SSA.

Funder

Canadian Institutes of Health Research

Fonds de Recherche du Québec - Santé

Faculty of Medicine, McGill University

Bill and Melinda Gates Foundation

Canada Research Chairs

Publisher

Ovid Technologies (Wolters Kluwer Health)

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