Antenatal Care - Testing and Counseling
Gaps in Research
- 1.
- Further interventions are needed to incorporate violence prevention, screening and counseling services into PMTCT testing and counseling.
- 2.
- Additional efforts are needed to improve information and counseling about HIV during ANC to ensure that pregnant woman and their sexual partners have adequate information.
- 3.
- Additional efforts are needed to ensure confidentiality in testing.
- 4.
- Increased support is needed for HIV serostatus disclosure, particularly at key times such as delivery, infant weaning, and at the resumption of sexual activity.
- 5.
- Further interventions are needed to provide couples counseling and testing to reduce seroconversion during pregnancy.
- 6.
- Multiple strategies are needed to promote male involvement in ways that meet pregnant women’s needs.
- 7.
- Further interventions are needed to reduce barriers to HIV testing.
- 8.
- Improved record keeping on HIV counseling, serostatus, and treatment is needed to improve referrals and linkages with other health care services.
- 9.
- HIV testing must be linked to access to treatment.
1. Further interventions are needed to incorporate violence prevention, screening and counseling services into PMTCT testing and counseling. Studies found high rates of violence, sexual coercion and abuse among HIV-positive pregnant women, particularly when accessing HIV testing or during disclosure.
Gap noted, for example, in Nigeria (Ezechi et al., 2009); Zimbabwe (Shetty et al., 2008a); Malawi (Bobrow et al., 2008); Kenya (Kiarie et al., 2006; Gaillard et al., 2002:) and South Africa (Dunkle et al., 2004).
Ezechi, O., C. Gab-Okafor, D. Onwujekwe, R. Adu, E. Amadi and E. Herbertson. 2009. “Intimate Partner Violence and Correlates in Pregnant HIV Positive Nigerians.” Archives of Gynecology and Obstetrics 280 (5): 745-752 doi: 10.1007/s00404-009-0956-9
2. Additional efforts are needed to improve information and counseling about HIV during ANC to ensure that pregnant woman and their sexual partners have adequate information. Studies found significant numbers of pregnant women received HIV tests with no counseling and reported that HIV testing was a mandatory part of their antenatal care. Studies also found that HIV-positive women feared transmitting HIV to their babies through casual contact. Studies found some providers assured women that treatment guaranteed that there would be no vertical transmission. In addition, studies found that some couples erroneously believed that sex during pregnancy causes miscarriages.
Gap noted, for example, in India (Sinha et al., 2008; Van Hollen, 2007; Rogers et al., 2006); Uganda (Medley et al., 2008a); Vietnam (Nguyen et al., 2008f; Brickley et al., 2008); Kazakhstan (Sandgren et al., 2008); South Africa (Groves et al., 2008); Kenya (Delva et al., 2006); Thailand (Teeraratkul et al., 2005); India, Thailand, Philippines and Indonesia (Paxton et al., 2004a); and Nigeria (Onah et al., 2002).
Sinha, G., A. Dyalchand, M. Khale, G. Kulkarni, S. Vasudevan and R. C. Bollinger. 2008. “Low Utilization of HIV Testing During Pregnancy: What are the Barriers to HIV Testing for Women in Rural India?” Journal of Acquired Immune Deficiency Syndromes 47(2): 248-252.
3. Additional efforts are needed to ensure confidentiality in testing. Studies found that women were tested without their consent and that providers did not protect women’s confidentiality.
Gap noted, for example, in Vietnam (Oosterhoff et al., 2008) and Turkey (Ersoy and Akpinar, 2008).
Oosterhoff, P. A. Hardon, T. Nguyen, N. Pham and P. Wright. 2008. “Dealing with a Positive Result: Routine HIV Testing of Pregnant Women in Vietnam.” AIDS Care 20 (6): 654-659.
4. Increased support is needed for HIV serostatus disclosure, particularly at key times such as delivery, infant weaning, and at the resumption of sexual activity. Studies found that disclosure to partners was low and women reported needing additional support to disclose.
Gap noted, for example, in Côte d’Ivoire.
Tonwe-Gold, B., D. Ekouevi, C. Bosse, S. Toure, M. Koné, R. Becquet, V. Leroy, P. Toro, F. Dabis, W. El Sadr and E. Abrams. 2009. “Implementing Family-Focused HIV Care and Treatment: The First 2 Years’ Experience of the Mother-to-Child Transmission-Plus Program in Abidjan, Côte d’Ivoire.” Tropical Medicine and International Health 14(2): 204-212.
5. Further interventions are needed to provide couples counseling and testing to reduce seroconversion during pregnancy. Studies found that inadequate numbers of couples are counseled on safer sex during pregnancy and that despite national guidelines, repeat testing during pregnancy is not routinely done.
Gap noted, for example, in South Africa (Peltzer et al., 2009, Moodley et al., 2009); India (Vijayakumari et al., 2008); Swaziland (Keiffer et al., 2008); Zimbabwe (Tavengwa et al., 2007) and in southern Africa (Rutenberg et al., 2001).
Peltzer, K., L. Chao and P. Dana. 2009. “Family Planning among HIV Positive and Negative Prevention of Mother to Child Transmission (PMTCT) Clients in a Resource Poor Setting in South Africa.” AIDS Behavior 13(5): 973-9.
6. Multiple strategies are needed to promote male involvement in ways that meet pregnant women’s needs. Studies found that some women found their partners’ involvement controlling and/or violent and other women wanted more autonomy in health decision-making. Studies also found men lacked information on vertical transmission and felt excluded from PMTCT programs.
Gap noted, for example, in South Africa (Maman et al., 2008b); Tanzania (Theuring et al., 2008); and Uganda (Medley et al., 2008c; Medley et al., 2008d).
Maman, S., A. Groves, E. Smith, N. Makhayna, M. Pakkies, S. Mosmi and D. Moodley. 2008b. “Redefining Male Involvement in Prevention of Mother to Child Transmission (PMTCT) from Female Partner’s Perspectives.” Abstract THAC0405. XVII International AIDS Conference. Mexico City, Mexico. August 3-8.
7. Further interventions are needed to reduce barriers to HIV testing. Studies found that fear of partner notification, risk of domestic violence, the unreliability of rapid HIV tests, long waiting times at the clinic, costs for transport, lack of childcare and the need for partner consent were barriers to HIV testing. The impact of rapid testing during labor and delivery for HIV-positive women has yet to be assessed.
Gap noted, for example, in a global review of PMTCT (Pai and Klein, 2009); and Uganda (Homsy et al., 2007 cited in Pai and Klein, 2009).
Pai, N. and M. Klein, 2009. “Rapid Testing at Labor and Delivery to Prevent Mother-to-child Transmission in Developing Settings: Issues and Challenges.” Women’s Health5 (1): 55-62.
8. Improved record keeping on HIV counseling, serostatus, and treatment is needed to improve referrals and linkages with other health care services. A study found that record keeping of HIV staging and CD4 counts was inadequate.
Gap noted, for example, in a review of maternal care practices in Africa.
9. HIV testing must be linked to access to treatment.
Gap noted, for example, in Uganda.
Dahl, V., L. Mellhammar, F. Bajunirwe and P. Bjorkman. 2008. “Acceptance of HIV Testing among Women Attending Antenatal Care in Southwestern Uganda: Risk Factors and Reasons for Test Refusal.” AIDS Care 20 (6): 746-752.