Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa.
J Int AIDS Soc. 2020 Jan;23(1):e25441. doi: 10.1002/jia2.25441.
The virtual elimination of mother-to-child transmission of HIV cannot be achieved without complete maternal HIV testing. The World Health Organization recommends that women in high HIV prevalent settings repeat HIV testing in the third trimester, and at delivery or directly thereafter. The Western Cape Province (South Africa) prevention of mother-to-child transmission (PMTCT) guidelines recommend a repeat maternal HIV test between 32 and 34 weeks gestation and at delivery in addition to testing at the first antenatal visit (ideally <20 weeks gestation). There are few published longitudinal studies on the uptake of initial and repeated maternal HIV testing programmes in sub-Saharan Africa. We aimed to investigate the implementation of initial and repeat maternal HIV testing guidelines in Cape Town, South Africa.
Between 2013 and 2016 we established an electronic PMTCT register that consolidated routine data from a primary healthcare facility and its secondary and tertiary referral sites in Cape Town. This provided a longitudinal record for each participant, from first antenatal visit to delivery. Utilizing these data, we conducted a retrospective analysis investigating the completeness of maternal HIV testing according to the PMTCT HIV testing guidelines in Cape Town, and predictors of complete testing, from 2014 to 2016.
Among 8558 enrolled pregnant women, 7213 (84%) were not known to be HIV positive at their first visit and thus eligible for HIV testing; 91% of them received ≥1 HIV test during pregnancy/delivery. Testing at the first visit was 98% among the 85% of women who attended antenatal care. Among women eligible to receive all three recommended HIV tests, only 11% achieved all three tests. Delivery HIV testing completion among all women without an HIV-positive diagnosis was 23%. HIV prevalence at delivery was 21% and HIV incidence between first visit and delivery in those with ≥2 HIV tests was 0.2%. Women who enrolled after 2014 were more likely to receive the three recommended tests (aOR: 1.41; 95% CI: 1.10 to 1.81) and retest at delivery (aOR: 1.20; 95% CI: 1.05 to 1.39).
Implementation of maternal HIV testing in Cape Town improved between 2014 and 2016 but major gaps remain, particularly at delivery.
如果不进行全面的孕产妇 HIV 检测，就无法实现母婴传播的虚拟消除。世界卫生组织建议，在高 HIV 流行地区，妇女应在第三孕期重复 HIV 检测，并在分娩时或之后立即进行。西开普省（南非）预防母婴传播（PMTCT）指南建议，除了在第一次产前检查时（理想情况下<20 周妊娠）进行检测外，还应在妊娠 32 至 34 周时和分娩时重复进行一次孕产妇 HIV 检测。在撒哈拉以南非洲地区，很少有关于初始和重复孕产妇 HIV 检测方案实施情况的已发表的纵向研究。我们旨在调查南非开普敦初始和重复孕产妇 HIV 检测指南的实施情况。
2013 年至 2016 年期间，我们建立了一个电子 PMTCT 登记处，该登记处整合了开普敦一家初级保健机构及其二级和三级转诊机构的常规数据。这为每位参与者提供了从第一次产前检查到分娩的纵向记录。利用这些数据，我们从 2014 年至 2016 年进行了一项回顾性分析，调查了根据开普敦 PMTCT HIV 检测指南进行的孕产妇 HIV 检测的完整性，以及完全检测的预测因素。
在 8558 名登记的孕妇中，有 7213 名（84%）在第一次就诊时未被发现 HIV 阳性，因此有资格进行 HIV 检测；其中 91%的人在妊娠/分娩期间接受了≥1 次 HIV 检测。在接受产前保健的 85%的妇女中，第一次就诊时的检测率为 98%。在有资格接受所有三次推荐 HIV 检测的妇女中，只有 11%的人接受了三次检测。所有未被诊断为 HIV 阳性的妇女在分娩时完成 HIV 检测的比例为 23%。分娩时 HIV 流行率为 21%，在那些接受≥2 次 HIV 检测的妇女中，从第一次就诊到分娩期间的 HIV 发病率为 0.2%。在 2014 年后登记的妇女更有可能接受三次推荐的检测（aOR：1.41；95%CI：1.10 至 1.81）和分娩时的重复检测（aOR：1.20；95%CI：1.05 至 1.39）。
2014 年至 2016 年期间，开普敦的孕产妇 HIV 检测实施情况有所改善，但仍存在重大差距，特别是在分娩时。
