Confined vulnerability of HIV infection among pregnant women attending antenatal care clinics in Karnataka, India: Analysis of data from the HIV sentinel surveillance 2017

Abstract

Background: HIV Sentinel Surveillance among pregnant women attending antenatal care clinics, ANC-HSS, is used to estimate HIV prevalence among the general population. Despite the declining trend, HIV prevalence among the general population in Karnataka is still higher than the national average (0.22%), with a recent, noticeable stabilization. Demographic analysis on concentrated HIV infection among pregnant women could be potential indicators for targeted HIV interventions among general population as well as and prevention of parent to child transmission (PPTCT). Objectives: To analyse the demographics of HIV-positive pregnant mothers in Karnataka, thereby identifying the most-at-risk populations (MARP) within the general population. Methods: In total, 24800 eligible pregnant women aged 15-49 attending the ANC clinic for the first time during the surveillance period (Jan-Mar, 2017) were enrolled. Demographic data and blood samples were collected, recorded and tested for HIV. Age-specific factors associated with HIV prevalence, besides the demographics of the HIV positive pregnant women, were analysed to identify the MARP for targeted HIV interventions. Results: Comprehensively, none of the demographic factors was significantly associated with HIV prevalence. Nevertheless, analysis of demographics, HIV test history and ART status of HIV-positive pregnant women reveals prominent prevalence patterns. The epidemic was majorly confined within young, less educated, primigravida and rural mothers of low economic status. Conclusion: ANC-HSS is designed to estimate the HIV prevalence among general population at national, state and district levels and is not reflective of the concentrated epidemic confined to MARP. Identifying the disease pattern specific to MARP is essential for effective targeted interventions and disease management.

An Analysis of Levels and Trends in HIV Prevalence Among Pregnant Women Attending Antenatal Clinics in Karnataka, South India, 2003-2019

“…7,8 While spouse occupation being laborers, seasonal migration and commercial sex trade were associated with infection risks in North Karnataka, spouse occupation being truckers and transport workers were associated with infection risks in South Karnataka. 8,9 It is noteworthy that although no significant variation was observed in the overall urban-rural prevalence in Karnataka, HIV positivity in the recent rounds was comparatively higher in the rural areas (Table 3). In 2019, HIV prevalence in the rural sites ranged between 0.00% -2.13%, and the rural sites in Bangalore Rural (2.13%), Bijapur (0.77%), Belgaum (0.68%), Raichur (0.63%) Bagalkot (0.62%) and Davanagare (0.57%) recorded higher prevalence.…”

“… 8 A previous study that analyzed the sociodemographic characteristics of HIV-positive pregnant women in Karnataka indicated that HIV was concentrated among pregnant women who were young and less educated, in their first gravida, residing in rural regions. 9 While the levels and trends of HIV prevalence at the national and state level are available, probing further into the region and district-wise levels and trends of HIV prevalence will provide critical insights on district-level epidemic patterns for region-specific tailor-made interventions. Hence, this paper analyzes the HSS data of pregnant women to derive the district-wise levels and trends of HIV prevalence in Karnataka.…”

Vulnerability in maternal, new-born, and child health in low- and middle-income countries: Findings from a scoping review

“…Biological . Two studies used biological vulnerability in the context of maternal health: risk of comorbid anxiety and depression in pregnancy [ 31 ], and HIV positivity [ 28 ].…”

“…Of the included studies, 22 (34%) were publications on vulnerability in the context of maternal health; most studies focused on a single country, while two focused on multiple countries. The studies were conducted across 15 countries, four were from Brazil, and two from India, Pakistan and Chile [24][25][26][27][28][29][30][31][32][33].…”

Cases of HIV testing among pregnant women attending antenatal care during COVID-19 pandemic: analysis of data surveillance

“…In an effort to avoid HIV transmission from mother-to-child, knowing pregnant woman's HIV status enables her to initiate an urgent MTCT prevention program (PPIA). HIV counseling and testing are also included as a starting point in UNAIDS' approach for 'getting to zero' [1].…”