Using routine programmatic data to measure HIV incidence among pregnant women in Botswana

Abstract Introduction: Pregnant women in sub-Saharan Africa have high risk of HIV acquisition, yet approaches for measuring maternal HIV incidence using routine surveillance systems are undefined. We used programmatic data from routine antenatal care (ANC) HIV testing in Botswana to measure real-world HIV incidence during pregnancy. Methods: From January 2018 to September 2019, the Botswana Ministry of Health and Wellness implemented an HIV testing program at 139 ANC clinics. The program captured information on testers’ age, testing date and result, and antiretroviral treatment (ART) initiation. In our analysis, we excluded individuals who previously tested HIV-positive prior to their first ANC visit. We defined incident HIV infection as testing HIV-positive at an ANC visit after a prior HIV-negative result within ANC. Results: Overall, 29,570 pregnant women (median age 26 years, IQR 22-31) tested for HIV at ANC clinics: 3% (836) tested HIV-positive at their first recorded ANC visit and 97% tested HIV-negative (28,734). Of those who tested HIV-negative, 28% (7,940/28,734) had a repeat HIV test recorded at ANC. The median time to HIV re-testing was 92 days (IQR 70-112). In total, 17 previously undiagnosed HIV infections were detected (HIV incidence 8 per 1,000 person-years, 95% CI 0.5-1.3). ART initiation among women newly diagnosed with HIV at ANC (853) was 88% (671/762). Conclusions: In Botswana, real-world HIV incidence among pregnant women at ANC remains above levels of HIV epidemic control (≤1 per 1,000 person-years). This study shows how HIV programmatic data can answer timely population-level epidemiological questions and inform ongoing implementation of HIV prevention and treatment programs.

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Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study

JMIR Public Health and Surveillance ◽

10.2196/17107 ◽

2020 ◽

Vol 6 (2) ◽

pp. e17107

Author(s):

Andrew D Maher ◽

Tuli Nakanyala ◽

Nicholus Mutenda ◽

Karen M Banda ◽

Dimitri Prybylski ◽

...

Keyword(s):

Hiv Testing ◽

Rural Areas ◽

Sub Saharan Africa ◽

Hiv Incidence ◽

Community Based ◽

Home Based ◽

Hiv Test ◽

Hiv Acquisition ◽

Hiv Negative

Background Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. Objective The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. Methods Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. Results Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. Conclusions Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

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Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study (Preprint)

10.2196/preprints.17107 ◽

2019 ◽

Author(s):

Andrew D Maher ◽

Tuli Nakanyala ◽

Nicholus Mutenda ◽

Karen M Banda ◽

Dimitri Prybylski ◽

...

Keyword(s):

Hiv Testing ◽

Rural Areas ◽

Sub Saharan Africa ◽

Hiv Incidence ◽

Community Based ◽

Home Based ◽

Hiv Test ◽

Hiv Acquisition ◽

Hiv Negative

BACKGROUND Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. OBJECTIVE The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. METHODS Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. RESULTS Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. CONCLUSIONS Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

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Combination Partner HIV Testing Strategies for HIV-positive and HIV-negative Pregnant Women

Case Medical Research ◽

10.31525/ct1-nct04124536 ◽

2019 ◽

Author(s):

Keyword(s):

Pregnant Women ◽

Hiv Testing ◽

Hiv Positive ◽

Testing Strategies ◽

Hiv Negative

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HIV post-test practices: an online survey examining perceived delivery of HIV test results, post-test discussion and referral in healthcare settings across the WHO European Region

Sexual Health ◽

10.1071/sh15186 ◽

2016 ◽

Vol 13 (3) ◽

pp. 205 ◽

Cited By ~ 2

Author(s):

Stephen Bell ◽

Jordi Casabona ◽

Nino Tsereteli ◽

Dorthe Raben ◽

John de Wit

Keyword(s):

Hiv Testing ◽

Positive Test ◽

European Region ◽

Hiv Positive ◽

Test Results ◽

Negative Test ◽

Hiv Test ◽

Post Test ◽

Test Result ◽

Hiv Negative

Background The aim of this study was to assess perceptions of health professionals involved in HIV testing policy and practice in national settings across the WHO European Region regarding the delivery of HIV test results, post-test discussion and referral to specialist HIV services as recommended in authoritative guidelines. Methods: An online self-report survey was completed by a convenience sample of 338 respondents (response rate 34.1%) from 55 countries. Respondents worked with non-government organisations (49.4%), health services (32.8%), non-health service government agencies (6.2%) or other organisations (11.5%; e.g. prisons, education and research, international development). Results: Experts’ perceptions indicate that delivery of HIV-positive test results and related post-test discussion in their country generally corresponded to recommendations. However, results pointed to a significant gap perceived by experts between recommendations and the practice of delivering HIV-negative test results. Fewer respondents thought that suitable time is taken to deliver a negative HIV-test result (54.1%) than a positive result (73.1%). Also, fewer respondents thought there was a procedure for referral to specialist treatment, care and support services for people receiving a HIV-negative test result (34.9%) than for people receiving an HIV-positive test result (86.2%). Experts also reported low perceived use of communication technologies (i.e. telephone, email, text messaging, a secure website) for delivering HIV test results. Conclusions: This expert survey offers new insight into perceived HIV post-test practices in almost all national settings across the WHO European Region. The findings provide valuable guidance for future HIV testing guidelines for the WHO European Region.

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HIV Retesting of HIV-Negative Pregnant Women in the Context of Prevention of Mother-to-Child Transmission of HIV in Primary Health Centers in Rural Zambia: What Did We Learn?

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958218823530 ◽

2019 ◽

Vol 18 ◽

pp. 232595821882353 ◽

Cited By ~ 3

Author(s):

Justin Mandala ◽

Prisca Kasonde ◽

Titilope Badru ◽

Rebecca Dirks ◽

Kwasi Torpey

Keyword(s):

Pregnant Women ◽

Hiv Positive ◽

Antenatal Visit ◽

Mother To Child Transmission ◽

Child Transmission ◽

Loss To Follow Up ◽

Hiv Test ◽

Hiv Exposed ◽

Mother To Child ◽

Hiv Negative

Background: This observational study describes implementation of HIV retesting of HIV-negative women in prevention of mother-to-child transmission (PMTCT) services in Zambia. Methods: Uptake of retesting and PMTCT services were compared across age, parity, and weeks of gestation at the time of the first HIV test, antiretrovirals regime, and HIV early diagnosis results from infants born to HIV-positive mothers. Results: A total of 19 090 pregnant women were tested for HIV at their first antenatal visit, 16 838 tested HIV-negative and were offered retesting 3 months later: 11 339 (67.3%) were retested; of those, 55 (0.5%) were HIV positive. Uptake of the PMTCT package by women HIV positive at retest was not different but HIV-exposed infants born to women who retested HIV positive were infected at a higher rate (11.1%) compared to those born to women who tested HIV positive at their initial test (3.2%). Conclusion: We suggest rigorously (1) measuring the proportion of MTCT attributable to women who seroconvert during pregnancy and possibly adjust PMTCT approaches and (2) addressing the substantial loss to follow-up of HIV-negative pregnant women before HIV retesting.

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Reaching hard-to-reach men through home-based couple HIV testing among pregnant women and their male partners in Western Kenya: A qualitative study

10.21203/rs.3.rs-15630/v1 ◽

2020 ◽

Author(s):

Daisy Krakowiak ◽

Pamela Makabong’o ◽

Marielle Goyette ◽

John Kinuthia ◽

Alfred Onyango Osoti ◽

...

Keyword(s):

Qualitative Study ◽

Pregnant Women ◽

Hiv Testing ◽

Health Workers ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Male Partners ◽

Home Based ◽

Couple Testing ◽

Couple Hiv Testing

Abstract Background Globally only 79% of HIV positive adults know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach population for HIV testing. Home-based HIV couple testing during the antenatal period is a safe and effective method that has been used to test male partners of pregnant women. The goal of this qualitative study was to identify elements that made couple testing successful and describe important characteristics of this home-based intervention from couples’ perspectives. Methods Couples who received scheduled home-based couple testing during pregnancy in Kisumu, Kenya, were purposively sampled based on HIV status from January to May 2015. An interviewer administered all of the in-depth interviews and two coders were directly involved in the data analysis and reconciled codes several times in the process. Results Twenty-one couples were enrolled: 9 concordant HIV-negative couples, 8 HIV discordant couples, 3 HIV concordant HIV-positive couples, and 1 whose concordance status was unknown. Median age at the time of home-based couple testing was 24 and 28 years for women and men, respectively. Median relationship duration was 3 years and couples had a median of two pregnancies. The major themes that emerged were that home-based couple testing 1) removed the female burden of requesting couple testing, 2) overcame logistical barriers associated with clinic-based testing, 3) encouraged participants to overcome their fear of testing and disclosure, 4) was preferred due to privacy in the home, and 5) provided quality time with the health advisors. Importantly, some women appreciated individual testing at the clinic before couple testing and some couples preferred skilled, anonymous health advisors delivering the intervention rather than known community health workers. Conclusions The results of this qualitative study suggest that home-based couple testing during pregnancy overcame many of the barriers that limit men’s access to and uptake of clinic-based testing. It encouraged participants to overcome their fear of testing and disclosure through a setting that afforded privacy and quality time with skilled health advisors. These qualitative results may help design effective partner and couple HIV testing programs in the antenatal setting and alongside or within other assisted partner notification services.

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‘It is not fashionable to suffer nowadays’: Community motivations to repeatedly participate in outreach HIV testing indicate UHC potential in Tanzania

PLoS ONE ◽

10.1371/journal.pone.0261408 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261408

Author(s):

Josien de Klerk ◽

Arianna Bortolani ◽

Judith Meta ◽

Tusajigwe Erio ◽

Tobias Rinke de Wit ◽

...

Keyword(s):

Hiv Testing ◽

Ethnographic Study ◽

Hiv Positive ◽

Health Coverage ◽

Hiv Status ◽

Community Members ◽

Community Based ◽

Multidisciplinary Study ◽

Hiv Test ◽

Hiv Negative

Objective This study examined people’s motivations for (repeatedly) utilizing HIV testing services during community-based testing events in urban and rural Shinyanga, Tanzania and potential implications for Universal Health Coverage (UHC). Methods As part of a broader multidisciplinary study on the implementation of a HIV Test and Treat model in Shinyanga Region, Tanzania, this ethnographic study focused on community-based testing campaigns organised by the implementing partner. Between April 2018 and December 2019, we conducted structured observations (24), short questionnaires (42) and in-depth interviews with HIV-positive (23) and HIV-negative clients (8). Observations focused on motivations for (re-)testing, and the counselling and testing process. Thematic analysis based on inductive and deductive coding was completed using NVivo software. Results Regular HIV testing was encouraged by counsellors. Most participants in testing campaigns were HIV-negative; 51.1% had tested more than once over their lifetimes. Testing campaigns provided an accessible way to learn one’s HIV status. Motivations for repeat testing included: monitoring personal health to achieve (temporary) reassurance, having low levels of trust toward sexual partners, feeling at risk, seeking proof of (ill)-health, and acting responsibly. Repeat testers also associated testing with a desire to start treatment early to preserve a healthy-looking body, should they prove HIV positive. Conclusions Community-based testing campaigns serve three valuable functions related to HIV prevention and treatment: 1) enable community members to check their HIV status regularly as part of a personalized prevention strategy that reinforces responsible behaviour; 2) identify recently sero-converted clients who would not otherwise be targeted; and 3) engage community with general prevention and care messaging and services. This model could be expanded to include routine management of other (chronic) diseases and provide an entry for scaling up UHC.

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Improving uptake of prevention of mother-to-child HIV transmission services in Benue State, Nigeria through a faith-based congregational strategy

PLoS ONE ◽

10.1371/journal.pone.0260694 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260694

Author(s):

Michele Montandon ◽

Timothy Efuntoye ◽

Ijeoma U. Itanyi ◽

Chima A. Onoka ◽

Chukwudi Onwuchekwa ◽

...

Keyword(s):

Pregnant Women ◽

Hiv Testing ◽

Hiv Transmission ◽

Male Partner ◽

Hiv Positive ◽

Linkage Data ◽

Hiv Status ◽

Faith Based ◽

Hiv Test ◽

The Impact

Background Nigeria has low antiretroviral therapy (ART) coverage among HIV-positive pregnant women. In a previous cluster-randomized trial in Nigeria, Baby Shower events resulted in higher HIV testing coverage and linkage of pregnant women to ART; here, we assess outcomes of Baby Shower events in a non-research setting. Methods Baby Shower events, including a prayer ceremony, group education, music, gifting of a “mama pack” with safe delivery supplies, and HIV testing with ART linkage support for HIV-positive pregnant women, were conducted in eighty sites in Benue State, Nigeria. Client questionnaires (including demographics, ANC attendance, and HIV testing history), HIV test results, and reported linkage to ART were analyzed. Descriptive data on HIV testing and ART linkage data for facility-based care at ANC clinics in Benue State were also analyzed for comparison. Results Between July 2016 and October 2017, 10,056 pregnant women and 6,187 male partners participated in Baby Shower events; 61.5% of women attended with a male partner. Nearly half of female participants (n = 4515, 44.9%) were not enrolled in ANC for the current pregnancy, and 22.3% (n = 2,241) of female and 24.8% (n = 1,532) of male participants reported they had never been tested for HIV. Over 99% (n = 16,240) of participants had their HIV status ascertained, with 7.2% of females (n = 724) and 4.0% of males (n = 249) testing HIV-positive, and 2.9% of females (n = 274) and 2.3% of males (n = 138) receiving new HIV-positive diagnoses. The majority of HIV-positive pregnant women (93.0%, 673/724) were linked to ART. By comparison, at health facilities in Benue State during a similar time period, 99.7% of pregnant women had HIV status ascertained, 8.4% had a HIV-positive status, 2.1% were newly diagnosed HIV-positive, and 100% were linked to ART. Conclusion Community-based programs such as the faith-based Baby Shower intervention complement facility-based approaches and can reach individuals who would not otherwise access facility-based care. Future Baby Showers implementation should incorporate enhanced support for ART linkage and retention to maximize the impact of this intervention on vertical HIV transmission.

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Determinan Perilaku Tes Hiv pada Ibu Hamil di Kota Padang Tahun 2019

Jurnal Endurance ◽

10.22216/jen.v5i1.4564 ◽

2020 ◽

Vol 5 (1) ◽

pp. 46

Author(s):

Hamidatul Yuni ◽

Melia Andika

Keyword(s):

Public Health ◽

Health Care ◽

Pregnant Women ◽

Hiv Testing ◽

Reproductive Age ◽

Public Health Care ◽

Hiv Positive ◽

Cross Sectional ◽

Hiv Test ◽

The City

Women are a population prone to contracting and transmitting, the number of women suffering from HIV as much as 36.4%. In 2017 as many as 73 new cases of HIV positive women in the city of Padang, almost half were women of reproductive age, including 2 cases of HIV positive pregnant women. Integrated antenal service for pregnant women, one of which is by carrying out laboratory tests of HIV testing that are required for all pregnant women. Padang City has 20 HIV counseling and testing services and 18 of them are Public Health Care. The purpose of this study was to determine of HIV test behavior in pregnant women viewed from the level of knowledge, patients' perceptions of HIV, social and psychological support of patients. Research with a quantitative approach with cross sectional design, conducted in several Padang city health centers with the lowest coverage of HIV testing in pregnant women in the city of Padang. The sample of the study was 100 pregnant women who visited the Public Health Care in May 2019. The research instrument by the questionnaire method. Data analysis used univariate, bivariate and multivariate. The results showed there was social support is the most dominant variable influencing HIV testing in pregnant women. Perempuan merupakan populasi rawan tertular dan menularkan, jumlah perempuan yang menderita HIV sebanyak 36,4% . Tahun 2017 sebanyak 73 kasus baru wanita positif HIV di Kota Padang, hampir separoh merupakan wanita usia reproduksi, diantaranya 2 kasus ibu hamil positif HIV. Layanan antenal terpadu pada ibu hamil salah satunya dengan melaksanakan pemeriksaan laboratorium tes HIV yang diwajibkan bagi seluruh Ibu hamil. Kota Padang memiliki layanan konseling dan tes HIV sebanyak 20 dan 18 diantaranya adalah puskesmas. Tujuan penelitian ini Untuk mengetahui determinan perilaku tes HIV pada Ibu hamil dilihat dari tingkat pengetahuan, persepsi pasien terhadap HIV, dukungan sosial dan psikologis pasien. Penelitian dengan pendekatan kuantitatif dengan desain cross sectional, yang dilakukan di beberapa puskesmas kota Padang dengan cakupan pemeriksaan HIV terendah pada Ibu hamil di Kota Padang. Sampel penelitian adalah Ibu hamil yang berkunjung ke puskesmas pada bulan Mei 2019 sebanyak 100 orang. Instrumen penelitian dikumpulkan dengan metode angket. Analisis data menggunakan univariat, bivariat dan multivariat. Hasil penelitian menunjukkan Dukungan sosial merupakan variabel yang paling dominan mempengaruhi pemeriksaan HIV pada Ibu hamil.

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Low Proportion of Women who came knowing their HIV Status at First Antenatal Care Visit, Uganda, 2012-2016: A Descriptive Analysis of Surveillance Data

10.21203/rs.2.12401/v1 ◽

2019 ◽

Author(s):

Miriam Nakanwagi ◽

Lilian Bulage ◽

Benon Kwesiga ◽

Alex Riolexus Ario ◽

Doreen Agasha Birungi ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Hiv Testing ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Status ◽

Antenatal Care Visit ◽

Care Visit ◽

Hiv Test ◽

Significant Difference

Abstract Background HIV testing is the cornerstone for all HIV care and support services, including Prevention of Mother to Child Transmission of HIV (PMTCT). The earlier women of reproductive age know their HIV status, the better informed their reproductive decisions and their infants’ outcomes may be. We analyzed trends in known current HIV status among pregnant women attending their first antenatal care visit (ANC1) in Uganda, 2012-2016. Methods We conducted secondary data analysis using District Health Information Software2 data on all pregnant women who came for ANC1 during 2012-2016. Women who brought documentation with them to ANC1 of an HIV test within the previous four weeks or an HIV care card as evidence of being in HIV care were considered as knowing their HIV status in antenatal care clinics. We calculated proportions of women with known current HIV status at ANC1, and described the linear trends both nationally and regionally. We used improved Poisson regression with generalized linear models to test the statistical significance of the trend. Results There was no significant difference in the number of women that attended ANC1 visits over the years 2012 to 2016. The proportion of women that came with known HIV status was highest at 6.9% in 2016 and this was an increasing trend (p<0.001). Most of the regions had an increase in trend except the West Nile and Mid-Eastern (p<0.001). The proportion of women that came knowing their HIV positive status at ANC1 is slightly higher than that of women that were newly tested HIV positive at ANC1 in 2015 and 2016. Conclusion Although the gap in women that come at ANC1 without knowing their HIV positive status might be reducing, still a large proportion of women who were infected with HIV did not know their status before their ANC1 HIV test, indicating a major public health gap. Therefore, more efforts are still required to achieve full PMTCT. In light of the considerable number that comes not knowing their HIV positive status at ANC1, we recommend advocacy for early ANC attendance and hence HIV testing so that timely PMTCT interventions can be made.

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