Socio-demographic associations of HIV among women attending antenatal care in selected rural primary care facilities in South Africa's Eastern Cape province.

Abstract

Background: To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. Methods: A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. Results: A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2 – 43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42-141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29 years, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value<0.0001). Conclusion: Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.

Experiences of Mothers Living With HIV in a South African Prevention of Mother-to-Child Transmission of HIV Programme: A Qualitative Descriptive Study

“…Partner and family support emerged as important components of mothers' support systems, facilitating adherence and linkage to care in the PMTCT programme, which has been reported in other studies in Africa (Jones et al, 2021; Mabunda et al, 2021; Masereka et al, 2019). The support of the male partner (infant's father) was valued; however, for most of the participants, the partner's involvement was unsatisfactory.…”

“…This left the woman alone in her journey, having to cope with the stress of being diagnosed and the awareness of HIV transmission risk to her infant. Lack of or minimal spousal/partner involvement is reported as a contributing factor toward increased risk of HIV for HIV-exposed newborns (Mabunda et al, 2021; Nyandat & Van Rensburg, 2020). Some participants had not yet disclosed their HIV status to their partners and families because of the fear of stigmatization and lack of acceptance.…”

“…HIV remains a threat to newborns in sub-Saharan Africa despite numerous services available to achieve the goal of an HIV-free generation (Yah & Tambo, 2019). Contributing factors include lack of awareness of HIV status in women of reproductive age, not being on HIV treatment during pregnancy, lack of access to health care services, poverty, and high adolescent pregnancy rates (UNAIDS, 2021) and poor spousal/partner involvement (Mabunda et al, 2021; Nyandat & Van Rensburg, 2020). Routine “opt-out” testing for all pregnant women, a global strategy to improve case discovery and reduce the risk of transmission once ART is commenced (Kate et al, 2019), has had mixed prenatal care uptake in sub-Saharan Africa (Awopegba et al, 2020).…”