Department of Epidemiology, University of Washington, Seattle, WA, USA.
Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
Glob Health Sci Pract. 2022 Feb 28;10(1). doi: 10.9745/GHSP-D-21-00451.
HIV retesting during pregnancy/postpartum can identify incident maternal HIV infection and prevent mother-to-child HIV transmission (MTCT). Guidelines recommend retesting HIV-negative peripartum women, but data on implementation are limited. We conducted a cross-sectional study in Kenya to measure the prevalence of maternal HIV retesting in programs and HIV incidence.
Programmatic HIV retesting data was abstracted from maternal and child health booklets among women enrolled in a cross-sectional and/or seeking services during pregnancy, delivery, or 9 months postpartum in Kenya between January 2017 and July 2019. Retesting was defined as any HIV test conducted by MTCT programs after the initial antenatal care test or conducted as part of retesting policies at/after delivery for women not tested during pregnancy. Poisson generalized linear regression was used to identify correlates of programmatic retesting among women enrolled at 9 months postpartum.
Among 5,894 women included in the analysis, 3,124 only had data abstracted and 2,770 were enrolled in a cross-sectional study. Overall prevalence of programmatic HIV retesting was higher at 6 weeks (65%) and 9 months postpartum (72%) than in pregnancy (32%), at delivery (23%) and 6 months postpartum (28%) (<.001 for all comparisons). HIV incidence was 0.72/100 person-years (PY) (95% confidence interval (CI)=0.43,1.22) in pregnancy and 0.23/100 PY (95% CI=0.09, 0.62) postpartum (incidence rate ratio: 3.09; 95% CI=0.97, 12.90; =.02).
Maternal retest coverage was high at 6 weeks and 9 months postpartum but low during pregnancy. Strategies to ensure high retesting coverage and detect women with incident maternal HIV infection are needed.
怀孕期间/产后进行 HIV 复查可以发现新的产妇 HIV 感染，并预防母婴 HIV 传播（MTCT）。指南建议对 HIV 阴性的围产期妇女进行复查，但实施情况的数据有限。我们在肯尼亚进行了一项横断面研究，以衡量母婴保健方案中 HIV 复查的流行率和 HIV 发病率。
从肯尼亚 2017 年 1 月至 2019 年 7 月期间参加横断面研究或在妊娠、分娩或产后 9 个月期间寻求服务的母婴健康手册中提取母婴保健方案中的 HIV 复查数据。复查定义为 MTCT 方案在初始产前检查后或在未在妊娠期间接受检查的妇女在产后进行的复查政策中进行的任何 HIV 检测。采用泊松广义线性回归分析方法，确定产后 9 个月时参加研究的妇女接受方案性复查的相关因素。
在纳入分析的 5894 名妇女中，有 3124 名仅提取了数据，2770 名参加了横断面研究。6 周（65%）和 9 个月（72%）时方案性 HIV 复查的总体流行率高于妊娠（32%）、分娩（23%）和产后 6 个月（28%）（所有比较<.001）。怀孕期间 HIV 发病率为 0.72/100 人年（95%置信区间（CI）=0.43，1.22），产后为 0.23/100 人年（95% CI=0.09，0.62）（发病率比：3.09；95% CI=0.97，12.90；=.02）。
6 周和产后 9 个月时的产妇复查覆盖率较高，但妊娠时较低。需要制定策略以确保高复查覆盖率并发现新的产妇 HIV 感染。
