Individual, Partner, and Couple Predictors of HIV Infection among Pregnant Women in Malawi: A Case–Control Study
We aimed to understand drivers of HIV-infection in pregnant women in Malawi. The study was conducted in antenatal and labor and delivery wards. HIV-infected women and their partners (cases) were frequency matched in a 1:2 ratio based on age and screening location to HIV-uninfected women and their partners (controls) in a prevalent case–control study. Characteristics associated with female HIV infection were assessed using logistic regression modeling. At screening, HIV-infected women were more likely to have partners outside Lilongwe than HIV-uninfected women (24% vs. 0%, p < 0.0001). Case females were more likely to have HIV-infected study partners than control females (75% vs. 4%, p < 0.0001). The odds of female HIV-infection were higher if either couple member reported ≥ 2 lifetime marriages (OR 9.0, CI 2.6–30.9) or ≥ 3 lifetime partners (OR 18.0, CI 3.1–103.6) and lower if either reported past couple HIV testing and counseling (OR 0.1, CI 0.04–0.3). Targeting women with migrating partners, promoting couple HIV testing and counseling, and limiting partners could slow HIV transmission.
KeywordsHIV Counseling Testing Prevention Risk Couple
The study and NER were supported by the National Institute of Mental Health (K99MH104154). LAG and MCH were supported by the National Institute of Child Health and Human Development (4T32HD052468-09, R01HD080485 respectively). AW was supported by the Doris Duke International Clinical Research Fellowship. We would like to thank Lighthouse Trust and Lilongwe District Health Office for their support. We would like to thank Nivedita Bhushan for designing the database and Mary Kacheyo for providing HIV testing and counseling.
This study was funded by X the National Institute of Mental Health (K99MH104154).
Compliance with Ethical Standards
Conflict of interest
Authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.UNAIDS. The Gap Report. 2014.Google Scholar
- 2.UNAIDS. On the fast track to an AIDS free generation. 2016.Google Scholar
- 3.Government of Malawi Ministry of Health. Integrated HIV program report: January–March 2016.Google Scholar
- 6.World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: Swizerland; 2015.Google Scholar
- 11.Kumogola Y, Slaymaker E, Zaba B, Mngara J, Isingo R, Changalucha J, et al. Trends in HIV & syphilis prevalence and correlates of HIV infection: results from cross-sectional surveys among women attending ante-natal clinics in Northern Tanzania. BMC Public Health. 2010;13(10):553.CrossRefGoogle Scholar
- 17.President’s Emergency Plan for AIDS Relief, ICAP, CDC, Center for Social Responsibility, Naitonal Statistics Office, COM-JHP. Malawi population-based HIV impact assessment, MPHIA 2015-2016. Malawi population-based HIV impact assessment: a drop that counts. 2016.Google Scholar
- 24.Macro and National Statistics Office. Malawi demographic and health survey 2010. Malawi and Calverton, Maryland, USA: Zomba; 2011.Google Scholar
- 26.Rosenberg NE, Hauser BM, Ryan J, Miller WC. The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review. Sex Trans Infect. 2016;92(8):579–86.Google Scholar
- 30.World Health Organization. Couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: recommendations for a public health approach. Geneva, Swizerland: WHO Document Production Services; 2012.Google Scholar