|Year : 2016 | Volume
| Issue : 4 | Page : 206-209
HIV infection: Prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital, Makurdi, Nigeria
PO Eka, AO Ojabo, SK Hembah-Hilekaan, BT Utoo, O Audu, JO Ben-Ameh
Department of Obstetrics and Gynaecology, BSUTH, Makurdi, Nigeria
|Date of Web Publication||8-Dec-2017|
Dr. P O Eka
Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Benue State
Source of Support: None, Conflict of Interest: None
Background: Human immunodeficiency virus (HIV) testing of pregnant women and their partners is an important step in access to prevention of mother-to-child transmission (MTCT) services; pregnant women are at a high risk of seroconversion, which is associated with a high rate of MTCT. Repeat HIV testing in late pregnancy or in labor is worthwhile in areas with high HIV prevalence. This study aimed at determining HIV prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital.
Patients and Methods: This was a prospective cross-sectional study involving 432 cohorts of antenatal attendees. The HIV status of these women were determined at booking using rapid HIV kits: Determine ½, Stat-Pak, and Unigold Recombigen. Repeat testing was performed during labor among women who were HIV negative at booking to determine the seroconversion rate.
Results: Overall HIV prevalence among this cohort of women was 8.6%. The seroconversion rate during labor was 2.5% among women who were seronegative at booking. Majority of the participants were young (modal age = 26–29 years, 36%), belonged to middle class (60.9%) and upper class (17.6%), and had secondary (50.0%) or tertiary education (38.0%).
Conclusion: HIV prevalence and seroconversion rates are rather high. There is need for more aggressive PMTCT awareness advocacy and intervention to reduce the incidence of pediatric acquired immunodeficiency syndrome in our setting. Further studies to differentiate seroconversion from new infections in pregnancy are worthwhile PMTCT strategies.
Keywords: Antenatal care, HIV prevalence, HIV seroconversion, prevention of mother-to-child transmission
|How to cite this article:|
Eka P O, Ojabo A O, Hembah-Hilekaan S K, Utoo B T, Audu O, Ben-Ameh J O. HIV infection: Prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital, Makurdi, Nigeria. Arch Int Surg 2016;6:206-9
|How to cite this URL:|
Eka P O, Ojabo A O, Hembah-Hilekaan S K, Utoo B T, Audu O, Ben-Ameh J O. HIV infection: Prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital, Makurdi, Nigeria. Arch Int Surg [serial online] 2016 [cited 2018 Jan 21];6:206-9. Available from: http://www.archintsurg.org/text.asp?2016/6/4/206/220331
| Introduction|| |
The National human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AID) seroprevalence in Nigeria is 3.4% (2.9–3.4). Mother-to-child transmission (MTCT) of HIV accounts for over 90% of all pediatric infections in children less than 15 years of age, with Nigeria alone contributing to 20.9% of global new pediatrics HIV infections.
HIV testing of pregnant women (and their partners) is an important step in access to prevention of mother-to-child transmission (PMTCT) strategies, as well as in the promotion of maternal and family health. During pregnancy women are at a higher risk of seroconversion in areas with high HIV seroprevalence. Moreover, seroconversion during pregnancy is associated with a high rate of MTCT. Thus, it is recommended that HIV testing in early pregnancy and late pregnancy or at delivery reduces the risk of MTCT. Common obstacles to PMTCT intervention in low-resource settings include lack of qualified staff, limited infrastructure, low antenatal attendance, and high losses to follow-up.,, A recent meta-analysis published in 2014 reported an aggregate seroconversion rate of 3.8 per 100 person-years in African countries. Benue State which used to have the highest burden of HIV/AIDS in the country has witnessed a remarkable drop in its HIV seroprevalence from 12.7% to between 4.0% and 6.9%.
This study is borne out of a genuine desire to determine the HIV seroprevalence and seroconversion rate at delivery among our antenatal attendees, fill the gap in knowledge in this important component of PMTCT in our setting, and provide the unmet need of repeat HIV testing in labor or late pregnancy as worthwhile PMTCT strategy.
| Patients and Methods|| |
This was a prospective cross-sectional study carried out at the antenatal unit and labor ward of Benue State University Teaching Hospital, Makurdi, North-central, Nigeria. Convenience sampling method was employed in arriving at the sample size of 432 over a period of 12 months (October 1, 2015 to September 30, 2016).
The participants were consecutive pregnant women at 16 weeks' gestation or less who presented for booking at our antenatal clinic. The numbers of HIV-negative and HIV-positive pregnant women at booking were determined using Determine HIV 1/2 (Abbott Laboratories, Wiesbaden, Germany), and Unigold Recombigen (Trinity Biotech, Co Wicklow, Ireland). Stat-Pak (Chembio Diagnostic System, New York, USA) was used to confirm the HIV status of a participant in case of discrepancy in results of the initial parallel rapid tests. During labor, all the pregnant women who were HIV negative at booking were retested for their HIV serostatus and those who seroconverted during the antenatal period were determined. The inclusion criteria consisted of all the pregnant women at 16 weeks' gestation or less who gave informed written consent to participate in the study at booking; all the HIV negative pregnant women at 16 weeks or less at booking who gave written consent to be retested in labor. The exclusion criteria consisted of all pregnant women who booked at greater than 16 weeks' gestation; all pregnant women who declined to participate in the study irrespective of their gestational age at booking; those who had miscarriages, molar pregnancies, and blood transfusions. The opt-out HIV testing and counselling method was offered to all women attending the antenatal clinics.
HIV screening at booking was conducted by a qualified laboratory technologist at the BSUTH laboratory complex using Determine HIV 1/2 (Abbott Laboratories, Wiesbaden, Germany) and Unigold Recombigen (Trinity Biotech, Co Wicklow, Ireland) rapid tests. Discrepant results were confirmed with Stat-Pak (Chembio Diagnostic System, New York, USA) rapid test.
In labor, all the participants who were HIV negative at booking were rescreened with Determine HIV1/2 rapid and Unigold Recombigen tests by resident doctors who had been trained to carry out rapid tests on such participants or parturients. Stat-Pak was used to confirm discrepant parallel test results.
Quality control to ensure proper performance of the test kit for the reagents, methodology, and personnel was ensured through the internal procedural control included in the test and external control.
Participant information was collected through a pretested proforma using translators when necessary. Sociodemographic information including maternal age, marital status, socioeconomic status, level of education, ethnicity, and religion was recorded. Other variables included HIV status at booking at the antenatal clinic and in the labor ward. Data was analyzed using statistical package for social and health sciences (Version 20, IBM, Armonk, NY, USA). Informed consent was obtained from all participants.
| Results|| |
The mean age was 28.6 (±4.4) years and the modal age was the interval 26–29 years (n = 155, 36.0%) with a range of 18–42 years. Majority of the women were middle class (n = 263, 60.9%), 21.5% (93) were low class, and 17.6% (76) were upper class. Majority of the women had secondary education (n = 216, 50%), 164 (38.0%) had tertiary education, 40 (9%) had primary education, and 12 (3.0%) had nonformal/Quranic education [Table 1]. Two hundred and fifteen (96.1%) were Christians whereas 17 (3.9%) were Muslims. Two hundred and sixty-eight (62%) were Tivs, 155 (35.9%) were Idomas, and other ethnic groups (Hausas, Fulanis, Igbos, Yorubas, and Igedes) constituted 9 (2.1%).
Of the 432 cohorts of pregnant women who booked for antenatal care during the study period, 405 were HIV negative and 27 were HIV positive. During labor, 10 pregnant women out of the original 405 HIV negative women at booking were found to be HIV positive. The overall HIV prevalence among this cohort of women is 8.6% (37/432) [Table 2]. The seroconversion rate is 2.5% (10/405) [Table 3].
|Table 2: HIV Serostatus of the Pregnant Women at Booking and in labour (n=432)|
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|Table 3: HIV Serostatus in Labour of Pregnant Women who were HIV negative at Booking (n=405)|
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All our cohorts of women were married, had antenatal care, and had unprotected intercourse with only their spouses throughout the antenatal period. Those who seroconverted were unsure of their spouses' HIV serostatus. All efforts to get them to bring their husbands for HIV testing and counselling failed.
| Discussion|| |
The overall HIV prevalence of 8.6% among this cohort of pregnant women was high, although it was lower than the previous reported prevalence of 12.7% in Benue State. The current HIV prevalence in the state is 4.0–6.9%. This is attributed to the aggressive effort of National Agency for the Control of AIDS (NACA) and stakeholders. However, it is lower than HIV prevalence of 9.6% and 20.64% among antenatal attendees reported from Jos and Nnewi, respectively. Lower HIV prevalence rates among antenatal attendees have been reported from both within and outside the country, including 4.1 in Ibadan, Nigeria and 6.5% in St. Petersburg, Russia. The variation in HIV prevalence may be attributed to the sociodemographic differences of the study population and the different test methods employed by the researchers. Moreover, risk factors vary from one setting to another.
The HIV seroconversion rate of 2.5% found in this study is higher than the seroconversion rates of 0.6% in Jos, Nigeria, 1.02% in Namibia, and 1.21% in Abuja, Nigeria. Series from Malawi, South Africa, Tanzania, and Zimbabwe reported higher seroconversion rates of 7.9%, 5.2%, 5.3%, and 17.7%, respectively. These seroconversion rates among pregnant women in our setting underscore the fact that HIV infection remains a major public health problem in sub-Saharan Africa and requires more PMTCT efforts such as routine retesting every 3 months after HIV screening at booking.
Majority of the participants were young (modal age: 26–29 years, 36.0%) belonging to middle class (60.9%) and upper class (17.6%). This finding is similar to that of the series from Nnewi. Surprisingly, a South African study among antenatal attendees from predominantly low socioeconomic background in Durban reported a slightly lower seroconversion rate of 2.2% compared to 2.5% found in this study. Emphasis should be on facilitating access to quality PMTCT services in all socioeconomic classes. There was a tacit attempt by participants who seroconverted to conceal their spouses' HIV status. This may be attributable to the fear of stigmatization in our setting.
The main limitation of this study is the difficulty in determining whether the seroconversion occurred due to new infection or genuine seroconversion following a window period. Failure to obtain information on the HIV status of spouses of participants who seroconverted made it impossible for us to uncover who were serodiscordant or seroconcordant relationships. Determining the HIV status of male partners of antenatal attendees who are HIV negative at booking is an important PMTCT strategy.
We recommend a multicenter study as a follow-up to this study to have rates which can be generalized to the Nigerian population. Future studies should attempt to determine viral antigens in patients' serum at booking to distinguish genuine seroconversion from new infections as opposed to antibody tests used in this study. We recommend repeat HIV testing every 3 months after the booking HIV screening and in labor in all our facilities that provide antenatal care for women.
| Conclusion|| |
The HIV prevalence of 8.6% and HIV seroconversion rate of 2.5% among this cohort of antenatal attendees were rather high.
Our heartfelt gratitude and appreciation go to the entire staff of the antenatal clinic and the midwives in the labour ward for their selfless contribution to the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Federal Ministry of Health (Nigeria) National HIV and AIDS and Reproductive Health Surveys 2014. Federal Ministry of Health, Abuja.
UNAIDS. 2011 Report on the Global AIDS epidemic: The Global Challenge. Available at: htt://www.unaids.org. [Last accessed on 2015 Sep 16].
Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV infection in Infants: Recommendations for a Public Health Approach, 2010 version. WHO, Geneva. Accessed at htt://www.who.int/hiv/pub/mtct/antiretioviral 2010/en/index.html. [Last accessed on 2016 Dec 15].
Heembelar S, Habets N, Makukul Z, van Roosmalen J, van den Akker T. Repeat HIV Testing During Pregnancy and Delivery: Missed Opportunities in a Rural District Hospital in Zambia. Trop Med Int Health 2015;20:277-83.
Aizire J, Fowler MG, Coovadia HM. Operational issues and barriers to implementation of Prevention of Mother-to-Child Transmission of HIV (PMTCT) interventions in Sub-Saharan Africa. Curr HIV Res 2013;11:144-9.
Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E, et al
. High Acceptability of Voluntary Counselling and HIV-Testing but unacceptable loss to follow-up in a prevention of Mother-to-Child HIV Transmission programme in Rural Malawi: Scaling-up requires a different way of acting. Trop Med Int Health 2005;10:1242-50.
Drake AL, Wagner A, Richardson B, John-Stewart G. Incident HIV during pregnancy and post-partum and risk of Mother-to-Child HIV Transmission: A systematic review and meta-analysis. PLOS Med 2014;11:e1001068.
Benue State Records 5.6% HIV/AIDS Prevalence Rate. NACA-BENSACA National HIV Epidemiological survey; 2015.
Sagay AS, Musa J, Adewole AS, Imade GE, Ekwempu CC, Kapiga S, et al
. Rapid HIV testing and counselling in labour in a northern Nigerian setting. Afr J Reprod Health 2006;10:76-80.
Umeononihu OS, Ikechebelu JI, Okonkwo JEN, Udigwe GO, Mbachu II. The prevalence of HIV sero-positivity in late pregnancy among antenatal attendees with seronegative status in first half of pregnancy in Nnewi, south-eastern Nigeria. J HIV Human Reprod 2013;1:25-9.
Nkwocha GC, Adesina OA, Arowojolu AO, Bamgboye EA, Adewole IF, Ilesanmi AO. Sensitivity, specificity and predictive values of Determine HIV- 1/2™
Rapid HIV Screening Kit for detection of HIV antibodies among booked antenatal women in the University College Hospital, Ibadan. Open Access Scientific Reports 2012;1:461.
Kissin DM, Akatova N, Rakhmanova AG, Vinogradova EN, Voronin EE, Jamieson DJ, et al
. Rapid HIV testing and prevention of perinatal HIV transmission in high-risk maternity hospitals in St Petersburg, Russia. Am J Obstet Gynecol 2008;198:183:e1-7.
Imade GE, Sagay AS, Musa J, Ocheke AN, Adeniyi DS, Idighri M, et al
. Declining rate of infection withmaternal human immunodeficiency virus at delivery units in north-central Nigeria. Afr J Reprod Health 2013;17:138-45.
Boly L, Ndile J, Zwartz F, Sabwa H, Musyoka K, Namukwambi K, et al
. Screening for HIV seroconversion among pregnant women in rural Namibia. Rome, Italy: AIS(ed) International AIDS Society; 2011.
Ukaire BC, Agboghoroma CO, Durojaiye KW. The prevalence of human immunodeficiency virus infection among pregnant women in labour with unknown status and those with negative status early in the index pregnancy in a tertiary hospital in Nigeria. Afr J Reprod Health Sep 2015;19:137-43.
Taha TE, Dallabetta GA, Hoover DR, Chiphangwi JD, Mtimavalye LA, Liomba GN, et al
. Trends of HIV-1 and sexually transmitted diseases among pregnant and postpartum women in urban Malawi. AIDS 1998;12:197-203.
Rehle T, Shisana O, Pillay V, Zuma K, Puren A, Parker W. National HIV incidence measures: New insights into the South African epidemic. S Afr Med J 2007;97:194-9.
Mbena H, Seni J, Kajura A, Matovelo D, Kihunrwa A. Human immunodeficiency virus seroconversion and associated risk factors among pregnant women delivering at Bugando Medical Center in Mwanza, Tanzania. Ann Med Health Sci Res 2014;4:733-7.
] [Full text]
Mbizvo MT, Kasule J, Mahomed K, Nathoo K. HIV-1 seroconversion incidence following pregnancy and delivery among women seronegative at recruitment in Harare, Zimbabwe. Cent Afr J Med 2001;47:115-8.
Qolohle DC, Hoosen AA, Moodley J, Smith AN, Mlisana KP. Serological screening for sexually transmitted infections in pregnancy: Is there value in re- screening for HIV and screening at the time of delivery? Genitor-Urinary Med 1995;71:65-7.
[Table 1], [Table 2], [Table 3]