Fourteen years of surveillance of HIV-1 prevalence among pregnant women attending antenatal care clinics in western Uganda

Systematic review and meta-analysis of seroprevalence of human immunodeficiency virus serological markers among pregnant women in Africa, 1984-2020

BACKGROUND

Human immunodeficiency virus (HIV) is a major public health concern, particularly in Africa where HIV rates remain substantial. Pregnant women are at an increased risk of acquiring HIV, which has a significant impact on both maternal and child health.

AIM

To review summarizes HIV seroprevalence among pregnant women in Africa. It also identifies regional and clinical characteristics that contribute to study-specific estimates variation.

METHODS

The study included pregnant women from any African country or region, irrespective of their symptoms, and any study design conducted in any setting. Using electronic literature searches, articles published until February 2023 were reviewed. The quality of the included studies was evaluated. The DerSimonian and Laird random-effects model was applied to determine HIV pooled seroprevalence among pregnant women in Africa. Subgroup and sensitivity analyses were conducted to identify potential sources of heterogeneity. Heterogeneity was assessed with Cochran's Q test and I2 statistics, and publication bias was assessed with Egger's test.

RESULTS

A total of 248 studies conducted between 1984 and 2020 were included in the quantitative synthesis (meta-analysis). Out of the total studies, 146 (58.9%) had a low risk of bias and 102 (41.1%) had a moderate risk of bias. No HIV-positive pregnant women died in the included studies. The overall HIV seroprevalence in pregnant women was estimated to be 9.3% [95% confidence interval (CI): 8.3-10.3]. The subgroup analysis showed statistically significant heterogeneity across subgroups (P < 0.001), with the highest seroprevalence observed in Southern Africa (29.4%, 95%CI: 26.5-32.4) and the lowest seroprevalence observed in Northern Africa (0.7%, 95%CI: 0.3-1.3).

CONCLUSION

The review found that HIV seroprevalence among pregnant women in African countries remains significant, particularly in Southern African countries. This review can inform the development of targeted public health interventions to address high HIV seroprevalence in pregnant women in African countries.

Heterogeneous and decreasing HIV prevalence among women seeking antenatal care in Kinshasa, Democratic Republic of Congo

BACKGROUND

We examined HIV prevalence trends over 4.5 years among women receiving antenatal care in Kinshasa, Democratic Republic of Congo, by geographic location, clinic management and urbanicity.

METHODS

Quarterly proportions and 95% confidence intervals (CIs) of pregnant women with HIV positive results were determined using aggregate service provision and uptake data from 22 maternity units that provided vertical HIV prevention services from October 2004 to March 2009. Assuming linearity, proportions were assessed for trend via the Cochran-Armitage test. Multivariable binomial regression was used to describe detailed prevalence trends.

RESULTS

HIV testing was offered to 220,006 pregnant women; 210,348 (95.6%) agreed to be tested and 191,216 (90.9%) received their results. A total of 3999 women were found to be HIV positive, a prevalence of 1.90% (95% CI: 1.84-1.96%). The median quarterly proportion of women testing positive for HIV was 1.94% (range: 1.44-2.44%). Prevalence was heterogeneous in terms of maternity management, urbanicity and geographic location. Modeling suggested that the overall prevalence dropped from 2.04% (95% CI: 1.92-2.16%) to 1.77% (95% CI: 1.66-1.88%) over 4.5 years, a relative decrease of 13.2% (95% CI: 3.53-22.9%). Trend testing corroborated this decline (P < 0.01).

CONCLUSIONS

The decreasing HIV prevalence among Kinshasa antenatal care seekers is robust and encouraging. The relatively low prevalence and the weak existing healthcare system require prevention of mother-to-child transmission interventions that strengthen maternal and child healthcare service delivery. Complacency would be unwarranted: assuming a uniform national crude birth rate of 50/1000 and 1.8% antenatal HIV prevalence, approximately 7000 pregnant HIV infected women in Kinshasa, and 60,000 nationwide, are in need of care and prevention services yearly.

Breastfeeding practices of HIV-positive and HIV-negative women in Kabarole district, Uganda

Ugandan policy regarding infant feeding for HIV-positive mothers is replacement feeding (RF), if feasible; otherwise, exclusive breastfeeding (EBF) for 3 months is advised (or EBF for 6 months, if RF is still not feasible). HIV-negative mothers should practise EBF for 6 months. The study objective was to explore the association between maternal HIV status and breastfeeding practices in Kabarole, Uganda. Data were collected from questionnaires administered at home to 182 women (44 HIV-positive and 138 HIV-negative) 3 months post-partum and from medical charts. The HIV-negative women were matched on delivery date to HIV-positive women at a ratio of 3:1. Interviewers were blinded to HIV status. There was no statistically significant association between adherence to Ugandan national feeding guidelines and maternal HIV status in bivariate analysis [odds ratio (OR) = 1.52; confidence interval (CI): 0.76-3.04]. Multivariate analyses showed a significant association between adherence to feeding guidelines and child illness (OR = 0.40; CI: 0.21-0.79) and between adherence to feeding guidelines and rural residence in Burahya county (OR = 2.43; CI: 1.15-5.13). Many mothers do not follow the feeding guidelines for HIV infection. This region-specific information on breastfeeding practice determinants will be used to inform local Prevention of Mother-to-Child Transmission (PMTCT) programmes. The nature of the association between child illness and EBF should be further explored.