HIV Counseling and Testing for the Prevention of Mother-to-Child Transmission of HIV in Swaziland: A Multilevel Analysis
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HIV Counseling and Testing for the Prevention of Mother-toChild Transmission of HIV in Swaziland: A Multilevel Analysis Marguerite L. Sagna • Donald Schopflocher
Ó Springer Science+Business Media New York 2014
Abstract HIV counseling and voluntary testing during antenatal care have been proven to reduce the risk of HIV transmission from mother to child, through increasing knowledge about safe behaviors, ascertaining HIV status and increasing coverage of effective antiretroviral regimens. However, it remains that, in developing countries where 95 % of mother-to-child HIV transmissions (MTCT) take place, such interventions are not widely accessible or available. Using a nationally representative cross-sectional household survey, the present study aimed to examine individual- and contextual-level influences on the receipt of HIV pre-test counseling and uptake of HIV testing during the antenatal care period in Swaziland, a country highly burdened by HIV/ AIDS. The study sample was restricted to women aged 15–49 years with a live birth in the past five years preceding the survey and who received antenatal care for the most recent birth. The findings of this study indicated that only 62 % of women received pre-test counseling for the prevention of MTCT and no more than 56 % of women consented to be tested for HIV during antenatal care. The multilevel regression analysis revealed that the likelihood of receiving HIV pre-test counseling increases significantly with higher parity, education level, household wealth and antenatal visits while it is lower in areas where poverty is pervasive (OR = 0.474) and in rural regions (OR = 0.598) as well. Beyond all the significant predictors, undergoing pre-test counseling has M. L. Sagna (&) D. Schopflocher Centre for Health Promotion Studies, School of Public Health, University of Alberta, 3-270 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada e-mail: [email protected] D. Schopflocher Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
emerged as an important determinant of HIV testing. Receiving pre-test counseling increases the odds of accepting an HIV test by 77 %. Evidence from this analysis underscores bottlenecks and challenges that persist in increasing the need for and uptake of HIV preventive and treatment services to stop new HIV infections among children. Keywords HIV pre-test counseling HIV testing Mother-to-child transmission Multilevel modeling Swaziland
Introduction Substantial gains in child survival rates are being increasingly erased in many countries in sub-Saharan Africa because of severe pediatric HIV/AIDS. The magnitude of childhood HIV infection is indisputably alarming in this part of the world, which accounts for 91 % of the global 3.4 million HIV positive children under age 15 [1]. Most of these children became HIV positive by vertical transmission or mother to-child-transmission (MTCT), that is, they acquired the virus from their HIV infected mothers during pregnancy, birth or breastfeeding. In recent
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