HIV self‐testing and repeat testing in pregnancy and postpartum in Northern Nigeria

Abstract

Objective: Incident HIV infections in pregnant and breastfeeding mothers pose significant challenges to prevention of mother-to-child HIV transmission efforts in sub-Saharan Africa. We identified the predictors of willingness to self-test for HIV when retesting in pregnancy and postpartum among antenatal clients in a tertiary hospital in Northern Nigeria. Methods:Structured and validated questionnaires were administered to a cross section of antenatal attendees (n = 370) in March 2021. Willingness to self-test and adjusted odds ratios of potential predictors were generated from logistic regression models.Results: Of the 317 respondents who agreed to repeat HIV test during pregnancy, 29.3% (n = 93) were willing to self-test. Similarly, of those (n = 350) willing to retest after delivery, 27.4% (n = 96) were willing to self-test. Willingness to self-test during pregnancy was higher among respondents who were multiparous (2-4 births) (adjusted odds ratio, aOR = 2.40, 95% confidence interval CI, 1.14-6.43), employed (aOR = 1.49, 95% CI, 1.13-4.53)and those with at least secondary education (aOR = 2.96, 95% CI, 1. 43-11.47). In contrast, willingness to self-test was lower among those who were unaware of the husband's HIV status (aOR = 0.05, 95% CI, 0.02-0.13). Willingness to self-test after delivery was higher among respondents who were married (aOR = 15.41, 95% CI, 3.04-78.2), multiparous (aOR = 2.01, 95% CI, 1.27-5.63), employed (aOR = 1.59, 95% CI, 1.08-2.35) and had at least to secondary education (aOR = 6.12, 95% CI, 1.36-27.47). In contrast, willingness to self-test postpartum was lower among those who booked late (≥29 weeks) (aOR = 0.11, 95% CI, 0.022-0.52), those who were unaware of the risk of HIV transmission during breastfeeding (aOR = 0.29, 95% CI, 0.12-0.68) and participants who were unaware of the husband's HIV status (aOR = 0.076, 95% CI, 0.03-0.19). Conclusion: Willingness to self-test for HIV in pregnancy and postpartum was low in this population and was influenced by risk perception, socio-demographic and obstetric attributes. Communication interventions and training of potential mentor mothers among early adopters could improve self-testing in this group and similar settings.

Preferences and uptake of home-based HIV self-testing for maternal retesting in Kenya

“…This proportion is similar to the proportion of women who reported willingness to self-test during pregnancy/delivery in Nigeria. [32] Retesting coverage was higher for CB-RDT (85%) than HB-HIVST (15%), despite nearly one-third of women selecting HB-HIVST at enrollment. These results demonstrate a current preference and better uptake for CB-RDT, but also barriers to HB-HIVST among those who selected this approach.…”

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

“…Studies in Nigeria and elsewhere [54][55][56] have linked limited autonomy with poor reproductive, maternal and child health outcomes. Given the ongoing shift towards biomedical approaches to HIV prevention and treatment, such as pre-exposure prophylaxis (PreP) and treatment as prevention (TasP), our study emphasises the need to integrate autonomy-building interventions into health programs as well as address broader sociocultural barriers that limit autonomy and SRHR of women and young people [54,[56][57][58][59][60][61][62][63]. Similarly, increased likelihood of intergenerational sex, and transactional sex among AYA in the "testing site" subgroup suggests that informational gaps in HIV prevention information and intervention, including where and how to access testing services, could be a common driver of non-utilisation of HIV testing services and sexual activity observed in this subgroup.…”