Determinants of HIV infection among pregnant women in Cameroon: A contribution toward the elimination of vertical transmission in low- and middle-income countries

Abstract

AbstractBackgroundThe risk of HIV transmission during antenatal care (ANC) in Cameroon remains a concern. According to recent studies, the prevalence of HIV in the country is around 4.5%, which increases the likelihood of vertical transmission.ObjectiveTo identify the determinants of HIV infection among pregnant women attending antenatal clinics (ANC) in Cameroon and to estimate HIV seroprevalence.MethodsA cross-sectional study was conducted among ANC attendees aged ≥15 years from September 2022 to June 2023 in 324 health facilities in 08 regions of Cameroon (Adamaoua, Yaounde, East, Far-North, Douala, North, West, South). Sociodemographic and clinical data were collected using questionnaire. HIV screening was performed according to the national algorithm. Estimates of HIV seroprevalence and identification of its determinants using multivariable logistic regression (95% CI) were performed with Excel and SPSS 22 software.ResultsOverall, 10674 pregnant women were enrolled, with median [IQR] age 25 years [21– 30]; 40.0% at a secondary educational level; 44.1% married monogamously; 46.3% multiparous; 38.8% in the second quarter of pregnancy and 16.5% reporting at least one abortion. Overall HIV seroprevalence was 2.6% [95%CI: 2.33; 2.93]. Significantly higher prevalence was found with the regions of Adamaoua (aOR 3.78 [95%CI: 1.87-7.67], p<0.001), East (9.38 [5.6-15.67], p<0.001), North (3.07 [1.74-5.42], p<0.001), South (2.93 [1.66-5.16]; p<0.001); lack of education (2.08 [1.06-4.06], p=0.032), primary education (2.44 [1.32-4.50], p=0.004) and secondary education (2.29 [1.28-4.08], p=0.005) were significantly associated with HIV infection, while monogamous marriage (0.33 [0.22-0.51], p<0.001), the absence of abortion (0.59 [0.37-0.98], p=0.036) and large multiparous (0.38 [0.17-0.82]; p=0.015) were protective.ConclusionDespite the overall low-prevalence among pregnant women at national-level, several factors are associated with HIV in ANC, the absence or low-level of education, being elderly (>30 years), singleness, history of abortion and low parity predicted the HIV status during ANC. Thus, public health interventions towards these at-risk target groups will help to reduce new infections among pregnant women, hence contributing to achieve eMTCT in Cameroon.