Preventing HIV Infection in Pregnant Women in Western Uganda Through a Comprehensive Antenatal Care-Based Intervention: An Implementation Study

TL;DR

A new HIV prevention strategy for pregnant women in Uganda reduced risky behavior and increased partner involvement during antenatal care.

Contribution

A comprehensive ANC-based intervention significantly reduced HIV risk behavior and increased partner participation in prenatal care.

Findings

Risk behavior engagement during pregnancy decreased by half after the intervention.

Partner participation in antenatal care doubled from 13.7% to 29.4%.

The HIV incidence rate was nearly four times lower than in a pre-intervention group.

Abstract

We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53–10.26), women with positive or unknown partner HIV-status (2.86; 1.18–6.91), and women whose partners abused alcohol (2.68; 1.15–6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.

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