Gunn Jayleen K L, Asaolu Ibitola O, Center Katherine E, Gibson Steven J, Wightman Patrick, Ezeanolue Echezona E, Ehiri John E
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
J Int AIDS Soc. 2016 Jan 18;19(1):20605. doi: 10.7448/IAS.19.1.20605. eCollection 2016.
Current guidelines recommend inclusion of HIV testing in routine screening tests for all pregnant women. For this reason, antenatal care (ANC) represents a vital component of efforts to prevent mother-to-child transmission (PMTCT) of HIV. To elucidate the relationship between ANC services and HIV testing among pregnant women in sub-Saharan Africa, we undertook an analysis of data from four countries.
Four countries (Congo, Mozambique, Nigeria and Uganda) were purposively selected to represent unique geographical regions of sub-Saharan Africa. Using Demographic and Health Survey datasets, weighted crude and adjusted logistic regression models were used to explore factors that influenced HIV testing as part of ANC services. The study was approved by the Institutional Review Board of the University of Arizona.
Pooled results showed that 60.7% of women received HIV testing as part of ANC. Ugandan women had the highest rate of HIV testing as part of ANC (81.5%) compared with women in Mozambique (69.4%), Nigeria (54.4%) and Congo (45.4%). Difficulty reaching a health facility was a barrier in Congo and Mozambique but not Nigeria or Uganda. HIV testing rates were lower in rural areas, among the poorest women, the least educated and those with limited knowledge of HIV. In every country, crude regression analyses showed higher odds of being tested for HIV if women received their ANC services from a skilled attendant compared with an unskilled attendant. After adjusting for confounders, women in the total sample had 1.78 (99% CI: 1.45-2.18) times the odds of having an HIV test as part of their ANC if they went to a skilled attendant compared with an unskilled attendant.
There is a need for integration of HIV testing into routine ANC service to increase opportunities for PMTCT programmes to reach HIV-positive pregnant women. Attention should be paid to the expansion of outreach services for women in rural settings, and to the training, supervision and integration of unskilled attendants into formal maternal and child health programmes. Education of pregnant women and their communities is needed to increase HIV knowledge and reduce HIV stigma.
当前指南建议将艾滋病毒检测纳入所有孕妇的常规筛查项目。因此，产前保健是预防艾滋病毒母婴传播（PMTCT）工作的重要组成部分。为了阐明撒哈拉以南非洲地区孕妇的产前保健服务与艾滋病毒检测之间的关系，我们对来自四个国家的数据进行了分析。
有目的地选择了四个国家（刚果、莫桑比克、尼日利亚和乌干达）以代表撒哈拉以南非洲的不同地理区域。利用人口与健康调查数据集，采用加权粗逻辑回归模型和调整后的逻辑回归模型来探究影响艾滋病毒检测作为产前保健服务一部分的因素。该研究得到了亚利桑那大学机构审查委员会的批准。
汇总结果显示，60.7%的女性接受了艾滋病毒检测作为产前保健的一部分。与莫桑比克（69.4%）、尼日利亚（54.4%）和刚果（45.4%）的女性相比，乌干达女性接受艾滋病毒检测作为产前保健一部分的比例最高（81.5%）。在刚果和莫桑比克，难以到达医疗机构是一个障碍，但在尼日利亚和乌干达并非如此。农村地区、最贫困女性、受教育程度最低以及对艾滋病毒了解有限的人群中，艾滋病毒检测率较低。在每个国家，粗回归分析表明，与由非专业护理人员提供产前保健服务的女性相比，由专业护理人员提供服务的女性接受艾滋病毒检测的几率更高。在对混杂因素进行调整后，与由非专业护理人员提供服务的女性相比，如果由专业护理人员提供服务，总样本中的女性接受艾滋病毒检测作为产前保健一部分的几率是前者的1.78倍（99%置信区间：1.45 - 2.18）。
有必要将艾滋病毒检测纳入常规产前保健服务，以增加预防艾滋病毒母婴传播项目接触艾滋病毒阳性孕妇的机会。应关注扩大针对农村地区女性的外展服务，以及对非专业护理人员的培训、监督并将其纳入正规的母婴健康项目。需要对孕妇及其社区进行教育，以增加艾滋病毒知识并减少对艾滋病毒的污名化。
