Womens experiences with HIV testing during antenatal care in Rwanda

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Womens experiences with HIV testing during
antenatal care in Rwanda Batya Elul, Felix
Ndagije?, Dominique Roberfroid, Thérèse
Delvaux, Elvanie Munyana, Vianney Nizeyimana
(presenting author), Ruben Sahabo? Internation
al Center for AIDS Care and Treatment Programs,
Columbia University, Mailman School of Public
Health, New York, NY USA ?International Center
for AIDS Care and Treatment Programs, Columbia
University, Mailman School of Public Health,
Kigali, Rwanda Institute of Tropical Medicine,
Antwerp, Belgium Treatment and Research AIDS
Center, Ministry of Health, Kigali, Rwanda
BACKGROUND
RESULTS, CONTINUED
In Rwanda, despite a relatively low HIV
prevalence rate of 3, an estimated 22,000
children under the age of 16 are living with
HIV/AIDS and account for nearly 10 of all
infections nationwide. As most of these
infections are believed to be perinatally
acquired, services to prevent mother-to-child
transmission (PMTCT) have rapidly scaled up at
the national level from 33 sites in 2002 to 234
in 2006. As part of those services, women are
offered voluntary HIV counseling and testing at
their first ANC visit and counselors encourage
testing of their partners. As part of a larger
evaluation of the national PMTCT program, we
explored womens knowledge of and experiences
with these services and how they differed by HIV
status.

DESIGN/METHODS

• Cross-sectional survey at 12 nationally
  representative PMTCT sites (all using SD-NVP
  PMTCT prophylaxis regimen) selected using
  multi-stage sampling techniques
• Closed-ended interviews with 398 women (236
  HIV-infected and 162 HIV-uninfected) who received
  ANC and counseling/testing services at one of the
  study sites during their last pregnancy
• Number of HIV-infected and HIV-uninfected women
  fixed by design
• HIV-infected women sampled from ANC registers,
  contacted at home by site staff not affiliated
  with the study and invited to return to the
  clinic for an interview
• HIV-uninfected women recruited and interviewed
  when they presented with their infants for
  routine immunization visits
• Descriptive statistics used to compare
  experiences among HIV-infected and HIV-uninfected
  women

RESULTS

• Knowledge and timing of testing Most, but
  slightly and significantly more HIV-uninfected
  (88) than HIV-infected (80), women knew they
  would be offered HIV testing as part of their ANC
  (plt0.05) (Fig. 1). Women learned this from
  family/friends, from health workers or through
  interactions with the health system during a
  prior pregnancy, or from the radio or public
  service announcements. 92 of women were offered
  HIV testing at their first ANC visit as per
  national guidelines, 95 of them were tested that
  day and 92 received their results on that day,
  with no significant difference by HIV status
  (Fig. 2).
• Testing experience The vast majority of women
  (gt89) found the explanations they received about
  the test clear, but 10 of HIV-infected women
  still had questions after the pre-counseling
  sessions vs. 4 of HIV-uninfected women (plt0.05).
  While virtually all women reported very strong
  or strong recommendations from health workers
  to get tested, reports of pressure to get
  tested were restricted to 12-15 of women, with
  no difference by HIV status (Fig. 3).
• Disclosure and partner status HIV-infected (vs.
  -uninfected) women were significantly less likely
  to share their test results with partners (84
  vs. 96) and more likely to do so with someone
  else (73 vs. 61) (Fig. 4). About 95 of all
  women were requested to bring their partners for
  testing by a health worker but only 47 and 61
  of partners of HIV-infected and -uninfected
  women, respectively, were tested during the index
  pregnancy (Fig. 5). Ultimately 40 of all
  infected women and 19 of all uninfected women
  were unaware of their partners HIV status, and
  sero-discordance was reported by 21 of
  HIV-infected women and 3 of HIV-uninfected
  women (Fig. 6).

Fig. 1 Knew HIV testing would be offered during
ANC, by HIV status

CONCLUSIONS

• More than five years since the rollout of the
  Rwandan national PMTCT program, access to and
  uptake of HIV testing during ANC remain
  commendably high. Additional training is needed
  to ensure that health workers obtain meaningful
  consent from all women. Outreach and community
  education efforts are also critical to increase
  the number of partners tested.

ACKNOWLEDGEMENTS
The Government of Rwanda U.S. Centers for
Disease Control and Prevention Elizabeth Glaser
Pediatric AIDS Foundation Site staff, study
interviewers and participants