High Rates of HIV Seroconversion in Pregnant Women and Low Reported Levels of HIV Testing among Male Partners in Southern Mozambique: Results from a Mixed Methods Study

Schacht, Caroline De; Hoffman, Heather J.; Mabunda, Nédio; Lucas, Carlota; Alons, Catharina; Madonela, Ana; Vubil, Adolfo; Ferreira, Orlando C.; Calú, Nurbai; Santos, Iolanda; Jani, Ilesh; Guay, Laura

doi:10.1371/journal.pone.0115014

Cited by 37 publications

(44 citation statements)

References 25 publications

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“…Our HIV incidence estimate is consistent with other studies in Africa and a recent meta-analysis [5–8], and is comparable to those seen in discordant couples and sex workers, suggesting that pregnancy and postpartum is a period of appreciable susceptibility to HIV. [21, 22] Risk per coital act was also high, ~0.5 per 1000, considering that partner HIV serostatus was not directly measured and this estimate includes women whose partners were HIV-uninfected.…”

Section: Discussionsupporting

confidence: 90%

“…[4–8] Epidemiologic approaches to determine the influence of pregnancy and postpartum period on risk of HIV acquisition are challenged by difficulties in defining an appropriate comparison group. A recent meta-analysis using data from 19 cohorts representing 22,803 total person-years of follow-up reported a pooled HIV incidence rate of 3.8/100 person-years (95% Confidence Interval [CI]:3.0–4.6) during pregnancy or postpartum.…”

Section: Introductionmentioning

confidence: 99%

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HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics

Kinuthia

Drake²,

Matemo

et al. 2015

Aids

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Objective To determine the risk and cofactors for HIV acquisition during pregnancy and postpartum. Design Prospective cohort study Methods Pregnant women in western Kenya were enrolled if HIV seronegative at that visit or within 3 months. Serial HIV nucleic acid amplification tests (NAATs) were conducted at 1–3 month intervals to 9 months postpartum. Genital swabs were collected for detection of chlamydia and gonorrhea at baseline, and for trichomonas, bacterial vaginosis (BV), and yeast at baseline and follow-up. Results Among 1304 pregnant women, median age was 22 years, 78% were married for a median of 4 years, 66% reported knowing partner HIV status, and 8% reported using condoms. Study retention was 98%. During 1235 person-years of follow-up, HIV incidence was 2.31/100 person-years (95% Confidence Interval [CI]:0.71–4.10). Incident HIV was associated with syphilis (Hazard Ratio [HR] 9.18, 95% CI:2.15–39.3), chlamydia (HR 4.49, 95% CI:1.34–15.0), BV (HR 2.91, 95% CI:1.25–6.76), yeast (HR 3.46, 95% CI:1.46–8.19), STI history (HR 3.48, 95%, CI:1.31–9.27), lifetime number of sex partners, (HR 1.19, 95% CI:1.03–1.37), partner age discordance (HR 1.07 per year, 95% CI:1.02–1.13) and shorter marriage (HR 1.19 per year, 95% CI:1.03–1.38). No women with incident HIV reported an HIV-infected partner. In multivariate analyses, chlamydia, older partners, and yeast infection remained significant; however, power was limited. Conclusions Pregnant and lactating women may not perceive HIV risk and rarely used condoms. Prevention and treatment of genital infections and risk stratification to identify women for pre-exposure prophylaxis (PrEP) could decrease HIV acquisition in pregnant/lactating women.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics

Kinuthia

Drake²,

Matemo

et al. 2015

Aids

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“…All participants were in mutually disclosed HIV-serodiscordant couples and expressed strong motivation for preventing HIV. Up to 80% of pregnant African women are unaware of their partner’s HIV status and therefore our data cannot be generalized to all pregnant women at risk for HIV 32–34 . Our sample was limited by the number of Kenyan women who continued using PrEP through pregnancy in the Partners Demonstration Project.…”

Section: Discussionmentioning

confidence: 92%

“I Did Not Want to Give Birth to a Child Who has HIV”: Experiences Using PrEP During Pregnancy Among HIV-Uninfected Kenyan Women in HIV-Serodiscordant Couples

Pintye

Beima‐Sofie

Kimemia

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objectives The perceptions, motivations, and beliefs of HIV-uninfected women about PrEP use during pregnancy can influence its uptake and adherence. This study elicited the views of HIV-uninfected women with personal experience taking PrEP during pregnancy. Design Qualitative interviews were conducted with HIV-uninfected women who had personal experience taking PrEP while pregnant. Methods Semi-structured interviews were conducted with 21 HIV-uninfected Kenyan women in HIV-serodiscordant couples enrolled in an open-label PrEP demonstration project who became pregnant while using PrEP and continued PrEP through their pregnancy. Interviews were audio-recorded and transcribed into English. A qualitative descriptive analysis was performed, using a constant comparison approach to identify key themes related to PrEP use in pregnancy. Results Desire to remain HIV-uninfected and have an HIV-free infant were strong motivators influencing continued use of PrEP during pregnancy. Supporting HIV-infected partners and childbearing within an HIV-serodiscordant relationship were also motivators. Women had challenges distinguishing normal pregnancy symptoms from PrEP side effects and were concerned that observed side effects could be signs of danger for the infant related to PrEP exposure. Healthcare providers were important conduits of knowledge about PrEP, and continuity of PrEP providers throughout pregnancy facilitated adherence. Conclusions HIV-uninfected women in HIV-serodiscordant couples were motivated to use PrEP during pregnancy to remain HIV-uninfected and to have an HIV-free child, but had concerns about side effects. Healthcare providers will be important for PrEP messaging and adherence support in this unique population.

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“…Correct and early diagnosis of STIs is one of the cornerstones of its control, as it prevents complications and consequences from developing, and provides a unique opportunity for educational activities on the prevention of HIV infection [35].…”

Section: Introductionmentioning

confidence: 99%

Intellectual Corruption in Modern Science: A Case Study

2019

JCRC

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Sexually transmitted infections are among the most common public health problems worldwide. Female and male infertility, mother to child transmission, causing miscarriages or congenital disease, and increased risk for Human Immunodeficiency Virus infection (HIV) are some of their consequences. In Sub-Saharan Africa countries, such as Mozambique, the prevalence of these infections is high, women being those who carry the higher burden. Thus we developed this cross-sectional study with objective of characterizing some sexually transmitted infections, HIV infection, syphilis and trichomoniasis in pregnant women, verifying if their management was in accordance with guidelines and recommendations in the country and identifying practice, Knowledge and associated risk factors. Samples were collected from 253 pregnant women attending Centro de Saúde de Maxixe. Vaginal samples were obtained and observed microscopically by wet mount and direct microscopic examination (Trichomonas vaginalis). HIV antibody testing was performed with the tests Determine HIV-1/2 and Uni-GoldTM and against, T. pallidum by RPR, SD BIOLINE Syphilis 3.0 and Determine TP tests in plasma samples. In this study, 11.1% of the pregnant women were infected with HIV, 2.8% with active syphilis, 5.1% with Trichomonas vaginalis and 9.1% with yeast. Antibodies against T. pallidum were identified in 8,3% of these women. In relation to HIV, 7, 5% of them were new cases. Samples were taken from 253 pregnant women attending ante-natal outpatient consultation at the health centre, which were informed about the nature of the study and submitted to a semi-structured interview after signing the free informed consent. In this study, the inconsistency on condoms use and the existence of multiple partners by the participants contributing for these infections transmission. Participants have shown that they had information about these infections modes of transmission, as also which measures to use to prevent them. A significant number of women present with any symptom related to infections that were diagnosed to them, proving that the use of syndrome approach in vaginal discharge must be given some thought in relation to its value in this situation. The data obtained in this study shows that some gaps also exist in the prenatal care clinics of this Centre, from routine procedures that are not performed in accordance with MISAU recommendations. The high prevalence of some STI found in this population, their risk behavior, together with the non-observance of some guidelines in the management of those infections by the health personal very worrying. The implementation of a teaching program on quality control, prevention and management of these infections by the health professional seems to us to be of utmost importance, so these can act in accordance with the present guidelines and transmit correct information to the pregnant women who attend prenatal care.

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High Rates of HIV Seroconversion in Pregnant Women and Low Reported Levels of HIV Testing among Male Partners in Southern Mozambique: Results from a Mixed Methods Study

Cited by 37 publications

References 25 publications

HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics

HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics

“I Did Not Want to Give Birth to a Child Who has HIV”: Experiences Using PrEP During Pregnancy Among HIV-Uninfected Kenyan Women in HIV-Serodiscordant Couples

Intellectual Corruption in Modern Science: A Case Study

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