Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008

Seroprevalence and Efficacy of Prevention of Parent to Child Transmission Program Over a Decade in a Tertiary Care Hospital in Mumbai, Maharashtra

Background

Parent to child transmission is the major mode of spread of HIV. An effective national health program (PPTCT) has been designed under NACO which helps in reducing the spread of HIV by vertical transmission and improving the life of the women and her baby.

Methods

A retrospective study was done at a tertiary care hospital, including pregnant women registered and delivered, and those who came directly in labour at the hospital during a period of 10 years from January 2010 to December 2019. Pretest counselling, HIV testing, Post-test counselling were done, and antiretroviral prophylaxis was given as per the NACP guidelines. Sociodemographic characteristics, obstetric outcome and efficacy of PPTCT services were analysed.

Results

Out of the 63,947 antenatal mothers included, 61,061 (95.4%) accepted HIV testing. 177 of these tested positive (0.289%) with a significant reduction in the seroprevalence over the decade. Majority of seropositive women were primigravida; housewives from urban areas, from low income and educational background and with no history of any contraceptive use. Out of 718 live births, the MTCT rate was found to be 4.5% at 6 weeks over the whole decade and was noted to be 1.8 % at 18 months which is well within the goal of PPTCT program and hence elucidating the success. Seventy-four spouses of the 177 seropositive women tested positive, 55 tested negative and 49 did not undergo the HIV testing. Decline in the number of partners not undergoing testing was elicited. The discordant couple rate in the study was 31% and showed variable trend over the decade.

Conclusions

Our study has observed an overall increase in efficacy of PPTCT in terms of increased utilization of PPTCT through the decade, decrease in the vertical transmission and seroprevalence rate, increase in the acceptance rates of HIV testing by partner almost conquering the goal of NACO.

Frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance

To assess the frequency of pregnant women who accept HIV screening using rapid detection test and factors associated with acceptance we undertook a cross-sectional study conducted from July to December 2018. Women aged 20–45 years, who were pregnant and planned to deliver at the facility, were included. Women were counseled and offered about Human Immunodeficiency virus (HIV) screening. A total of 718 women were included in the study. The screening was accepted by 32.3% of women. Six women tested positive in the study giving a seroprevalence of 0.8% in the population studied. Acceptance of counseling and screening varied significantly with age range, educational status, socioeconomic status, and employment status. Women aged 30 years and above ( p = 0.023) and women with higher education ( p < 0.001) were more likely to refuse counselling. Similarly, employed women (p = 0.041) and women of higher socioeconomic class ( p = 0.039) refused counselling. However, when logistic regression was conducted, only educational status ( p < 0.001) and occupational status ( p = 0.039) were significantly associated with acceptance of counseling and screening. The acceptance of counselling and testing for HIV in antenatal care attendees was low. Women of higher educational status and having some employment refused counselling and testing more commonly.