Heterogeneity and confinement of HIV prevalence among pregnant women calls for decentralized HIV interventions: Analysis of data from three rounds of HIV sentinel surveillance in Karnataka: 2013–2017

Abstract

Background: The HIV sentinel surveillance (HSS) serves to estimate the levels and trend of HIV prevalence among high-risk, bridge, and general population and monitors HIV management at national, state, and district levels. Data from HSS are valuable in understanding the risk factors associated with HIV transmission with particular demographic characteristics. Objectives: The objective was to analyze the sociodemographic profile of the pregnant mothers attending the antenatal care (ANC) clinics in Karnataka, in order to understand the dynamics of HIV within the general population in Karnataka. Materials and Methods: Study design: this was a cross-sectional study conducted using consecutive sampling method. Study setting: the surveillance was conducted at select antenatal clinics, in Karnataka, India, between January and March, in the years 2013, 2015, and 2017. Methodology: in total, 74,278 eligible pregnant women aged between 15 and 49 years, attending the sentinel sites for the first time during the surveillance period, were included in the study. Information on their sociodemographic characteristics and blood samples was collected. Results: HIV prevalence among the ANC clinic attendees has significantly declined, reaching a recent stabilization. The risk factors significantly associated with HIV among pregnant women were age, education, occupation, and marital status. HIV is highly concentrated in the northern and southern districts of Karnataka. Conclusion: Despite the declining trends of HIV prevalence in Karnataka, the epidemic is heterogeneous and concentrated within the state, calling for decentralized region-specific interventions.

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

“…Previous studies show that HIV among pregnant women in Karnataka is highly concentrated in the northern (Belgaum region) and southern districts (Bangalore region), particularly those with high HIV prevalence among HRGs. 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).…”

“…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.…”

“… 7 Belgaum and Bangalore regions have consistently reported high HIV prevalence among antenatal clinic (ANC) attendees and the general population surveillance. 7 , 8 India’s HIV Sentinel Surveillance (HSS) facilitates periodic monitoring of HIV prevalence at national and state levels. Besides HIV prevalence estimations, HSS serves as a preliminary indicator of sociodemographic factors associated with HIV risk.…”

“…An analysis of recent HSS data reports a significant association of age, education, spouse occupation, and marital status with higher HIV prevalence among pregnant mothers and indicated that regions of high ANC-HIV prevalence were potentially those with high FSW-HIV 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.…”