Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda.
PLoS One. 2020 Jun 5;15(6):e0234174. doi: 10.1371/journal.pone.0234174. eCollection 2020.
The study attempted to determine the incidence of HIV among pregnant women in Kabarole District, Uganda, and to identify socio-demographic and behavioral risk factors for seroconversion during pregnancy.
We carried out a retrospective cohort study among women for whom a documented HIV-negative test result from the first pregnancy trimester could be confirmed using available records, and who were HIV-retested in the third trimester or during delivery. In total, 1610 pregnant women from three different healthcare settings took part in the study. We captured the results of repeated HIV tests and conducted semi-structured interviews to explore participants' socio-demographic characteristics and sexual risk behavior. For HIV incidence rates, we calculated the number of seroconversions per 100 person-years. We used Fisher's exact test to test for potential associations. Penalized maximum likelihood logistic regression and Poisson regression were applied to adjust for potential confounders.
The overall HIV incidence rate among participants was 2.9/100 women-years. Among socio-demographic characteristics, the multivariable analysis showed a significant association of marital status with HIV incidence in pregnancy (IRR 8.78, 95%CI [1.13-68.33]). Risky sexual behaviors including higher number of sexual partners in pregnancy (IRR 2.78 [1.30-5.94]), unprotected sex with unknown persons (IRR 14.25 [4.52-44.93]), alcohol abuse (IRR 12.08 [4.18-34.90]) and sex under the influence of drugs or alcohol (IRR 6.33 [1.36-29.49]) were significantly associated with seroconversion in pregnancy (similar results in logistic regression).
HIV incidence was three times higher among our pregnant study population compared to the general female population in Uganda. This underlines the importance of HIV prevention and repeat testing during pregnancy. Identified risk groups should be considered for pre-exposure prophylaxis.
本研究旨在确定乌干达卡巴罗莱区孕妇的 HIV 感染率，并确定怀孕期间血清转换的社会人口学和行为危险因素。
我们对符合以下条件的孕妇进行了回顾性队列研究：可通过现有记录确认首次妊娠前三个月的 HIV 阴性检测结果，并且在妊娠晚期或分娩时进行了 HIV 再次检测。共有来自三个不同医疗保健机构的 1610 名孕妇参与了这项研究。我们记录了重复 HIV 检测的结果，并进行了半结构化访谈，以探讨参与者的社会人口学特征和性行为风险。对于 HIV 发病率，我们计算了每 100 人年的血清转化率。我们使用 Fisher 精确检验来检验潜在的关联。应用惩罚最大似然逻辑回归和泊松回归来调整潜在的混杂因素。
参与者的总体 HIV 发病率为 2.9/100 人年。在社会人口学特征方面，多变量分析显示，婚姻状况与妊娠期间的 HIV 发病率显著相关（IRR 8.78，95%CI [1.13-68.33]）。包括怀孕期间性伴侣数量增加（IRR 2.78 [1.30-5.94]）、与不明身份的人无保护性行为（IRR 14.25 [4.52-44.93]）、滥用酒精（IRR 12.08 [4.18-34.90]）和在药物或酒精影响下发生性行为（IRR 6.33 [1.36-29.49]）等危险性行为与妊娠期间血清转换显著相关（逻辑回归中得到相似结果）。
与乌干达普通女性人群相比，我们的孕妇研究人群中的 HIV 发病率高出三倍。这强调了在怀孕期间进行 HIV 预防和重复检测的重要性。应考虑将确定的风险群体作为暴露前预防的对象。
