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Socioeconomic Inequalities and HIV Testing During Antenatal Care in High- Medium- and Low-Conflict Intensity Countries in Sub-Saharan Africa

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Abstract

Understanding HIV testing determinants in different settings is vital to reducing new infections. This study assessed HIV testing rates during antenatal care (ANC) in seven sub-Saharan African countries designated as high, medium, low or no conflict intensity settings. We ranked and plotted concentration curves for HIV testing by socioeconomic inequality and determined their concentration indices (CCI). Testing for HIV during ANC was highest in Zimbabwe (95.7%) and lowest in Sudan (3.6%). Countries with medium and high conflict intensity experienced higher HIV testing inequality (CCI = 0.38) than countries with low or no conflict (CCI = 0.15). Low HIV testing rates were associated with no education, rural areas, poorest wealth index quintiles and home birth, which demonstrate that determinants of HIV testing during ANC in conflict-affected areas are complex and context-based. Programme implementation and policymakers must acknowledge these complexities and local contexts in their program designs and planning.

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The data is available from UNICEF on request.

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References

  1. UNAIDS. 20.1 million girls and women living with HIV 2020. Available from: https://www.unaids.org/en/resources/infographics/girls-and-women-living-with-HIV

  2. Li L, Wu Z, Wu S, Jia M, Lieber E, Lu Y. Impacts of HIV/AIDS stigma on family identity and interactions in china. Fam Syst Health. 2008;26(4):431–42.

    Article  Google Scholar 

  3. Kontomanolis EN, Michalopoulos S, Gkasdaris G, Fasoulakis Z. The social stigma of HIV-AIDS: society’s role. HIV AIDS (Auckl). 2017;9:111–8.

    Google Scholar 

  4. Seeley J, Dercon S, Barnett T. The effects of HIV/AIDS on rural communities in East Africa: a 20-year perspective. Tropical Med Int Health. 2010;15(3):329–35.

    Article  Google Scholar 

  5. UNAIDS. Global HIV & AIDS statistics—2020 fact sheet 2020. Available from: https://www.unaids.org/en/resources/fact-sheet

  6. Kharsany ABM, Cawood C, Khanyile D, Lewis L, Grobler A, Puren A, et al. Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey. Lancet HIV. 2018;5(8):e427-37.

    Article  Google Scholar 

  7. Girum T, Wasie A, Lentiro K, Muktar E, Shumbej T, Difer M, et al. Gender disparity in epidemiological trend of HIV/AIDS infection and treatment in Ethiopia. Arch Public Health. 2018;76(1):51.

    Article  Google Scholar 

  8. Evan M, Risher K, Zungu N, Shisana O, Moyo S, Celentano DD, et al. Age-disparate sex and HIV risk for young women from 2002 to 2012 in South Africa. J Int AIDS Soc. 2016;19(1):21310.

    Article  Google Scholar 

  9. Pascoe SJS, Langhaug LF, Mavhu W, Hargreaves J, Jaffar S, Hayes R, et al. Poverty, food insufficiency and HIV infection and sexual behaviour among young rural Zimbabwean women. PLoS ONE. 2015;10(1):e0115290.

    Article  Google Scholar 

  10. Gómez-Suárez M, Mello MB, Gonzalez MA, Ghidinelli M, Pérez F. Access to sexual and reproductive health services for women living with HIV in Latin America and the Caribbean: systematic review of the literature. J Int AIDS Soc. 2019;22(4):e25273.

    Article  Google Scholar 

  11. UNAIDS. Women and HIV: A spotlight on adolescent girls and young women 2019. Available from: https://www.unaids.org/sites/default/files/media_asset/2019_women-and-hiv_en.pdf

  12. Wettstein C, Mugglin C, Egger M, Blaser N, Vizcaya LS, Estill J, et al. Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis. AIDS. 2012;26(18):2361–73.

    Article  Google Scholar 

  13. Barron P, Pillay Y, Doherty T, Sherman G, Jackson D, Bhardwaj S, et al. Eliminating mother-to-child HIV transmission in South Africa. Bull World Health Organ. 2013;91(1):70–4.

    Article  Google Scholar 

  14. UNAIDS. HIV infections among children falling 2019. Available from: https://www.unaids.org/en/resources/presscentre/featurestories/2019/may/20190513_pmtct

  15. Barker PM, Mate K. Eliminating mother-to-child HIV transmission will require major improvements in maternal and child health services. Health Aff. 2012;31(7):1489–97.

    Article  Google Scholar 

  16. Joint United Nations Programme on HIV/AIDS. Fast-Track—Ending the AIDS Epidemic by 2030: UNAIDS; 2014. Available from: http://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report

  17. Staveteig S, Croft TN, Kampa KT, Head SK. Reaching the ‘first 90’: gaps in coverage of HIV testing among people living with HIV in 16 African countries. PLoS ONE. 2017;12(10):e0186316.

    Article  Google Scholar 

  18. Abuogi LL, Humphrey JM, Mpody C, Yotebieng M, Murnane PM, Clouse K, et al. Achieving UNAIDS 90–90-90 targets for pregnant and postpartum women in sub-Saharan Africa: progress, gaps and research needs. J Virus Erad. 2018;4:33–9.

    Article  Google Scholar 

  19. Global Burden of Disease Pediatrics Collaboration. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: findings from the global burden of disease 2013 study. JAMA Pediatr. 2016;170(3):267–87.

    Article  Google Scholar 

  20. Chu D-T, Vo H-L, Tran D-K, Nguyen Si Anh H, Bao Hoang L, Tran Nhu P, et al. Socioeconomic inequalities in the HIV testing during antenatal care in Vietnamese women. Int J Environ Res Pub Health. 2019;16(18):3240.

    Article  Google Scholar 

  21. Ziegler BR, Kansanga M, Sano Y, Kangmennaang J, Kpienbaareh D, Luginaah I. Antenatal care utilization in the fragile and conflict-affected context of the democratic republic of the Congo. Soc Sci Med. 2020;262:113253.

    Article  Google Scholar 

  22. World Health Organization. New Guidelines on Antenatal Care for a Positive Pregnancy Experience Geneva: WHO; 2016. Available from: https://www.who.int/reproductivehealth/news/antenatal-care/en/

  23. The World Bank. Classification of Fragile and Conflict-Affected Situations 2020. Available from: https://www.worldbank.org/en/topic/fragilityconflictviolence/brief/harmonized-list-of-fragile-situations

  24. The World Bank. Revised Classification of Fragility and Conflict Situations for World Bank Group Engagement 2021. Available from: https://pubdocs.worldbank.org/en/964161594254019510/Revised-Classification-of-Fragility-and-Conflict-Situations-web-FY21.pdf

  25. The World Bank. FY21 List of Fragile and Conflict-affected Situations 2021. Available from: https://pubdocs.worldbank.org/en/888211594267968803/FCSList-FY21.pdf

  26. Hakim AJ, Bolo A, Werner M, Achut V, Katoro J, Caesar G, et al. High HIV and syphilis prevalence among female sex workers in Juba, South Sudan. PLoS ONE. 2020;15(9):e0239543.

    Article  CAS  Google Scholar 

  27. Jervase A, Tahir H, Modi JK, Almobarak AO, Mital D, Ahmed MH, et al. HIV/AIDS in South Sudan past, present, and future: a model of resilience in a challenging context. J Public Health Emerg. 2018;2(31):1–5.

    Google Scholar 

  28. Badawi MM, Atif MS, Mustafa YY. Systematic review and meta-analysis of HIV, HBV and HCV infection prevalence in Sudan. Virol J. 2018;15(1):148.

    Article  CAS  Google Scholar 

  29. Zimbabwe Ministry of Health and Child Care (MOHCC). Zimbabwe Population_based HIV Impact Assessment: ZIMPHIA 2015–2016 Harare: Zimbabwe Ministry of Health and Child Care (MOHCC); 2019. Available from: https://phia.icap.columbia.edu/wp-content/uploads/2019/08/ZIMPHIA-Final-Report_integrated_Web-1.pdf

  30. Nigeria Federal Ministry of Health. Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018 Technical Report Abuja: Nigeria Federal Ministry of Health; 2019. Available from: http://ciheb.org/media/SOM/Microsites/CIHEB/documents/NAIIS-Report-2018.pdf

  31. Pour M, James L, Singh K, Mampunza S, Baer F, Scott J, et al. Increased HIV in greater kinshasa urban health zones: democratic republic of Congo (2017–2018). AIDS Res Ther. 2020;17(1):67.

    Article  Google Scholar 

  32. Institute of Statistical Social and Economic Research (ISSER). Policy Brief: Current HIV/AIDS Status, Access to Antiretroviral Treatment, and HIV-Related Stigma in Ghana: College of Humanities, University of Ghana; 2020. Available from: https://isser.ug.edu.gh/sites/isser.ug.edu.gh/files/Current%20HIV.AIDS%20Status%20-%20Adobea%20Owusum%20%26%20Kofi%20Asante.pdf

  33. WHO. WHO recommendations on antenatal care for a positive pregnancy experience Geneva, Switzerland: WHO Press; 2016. Available from: https://www.who.int/publications/i/item/9789241549912

  34. Tlhajoane M, Masoka T, Mpandaguta E, Rhead R, Church K, Wringe A, et al. A longitudinal review of national HIV policy and progress made in health facility implementation in Eastern Zimbabwe. Health Res Policy Syst. 2018;16(1):92.

    Article  Google Scholar 

  35. Ajayi A, Awopegba O, Owolabi E, Ajala A. Coverage of HIV testing among pregnant women in Nigeria: progress, challenges and opportunities. J Public Health. 2019;43(1):e77-84.

    Article  Google Scholar 

  36. Khan S, Hancioglu A. Multiple indicator cluster surveys: delivering robust data on children and women across the globe. Stud Fam Plann. 2019;50(3):279–86.

    Article  Google Scholar 

  37. Castillo-Salgado C, Schneider C, Loyola E, Mujica O, Roca A, Yerg T. Measuring health inequalities: gini coefficient and concentration index. Epidemiol Bull. 2001;22(1):3–4.

    Google Scholar 

  38. O’donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington: The World Bank; 2007.

    Book  Google Scholar 

  39. Uldbjerg CS, Schramm S, Kaducu FO, Ovuga E, Sodemann M. Perceived barriers to utilization of antenatal care services in Northern Uganda: a qualitative study. Sex Reprod Healthc. 2020;23:100464.

    Article  Google Scholar 

  40. Tenthani L, Haas AD, Egger M, van Oosterhout JJ, Jahn A, Chimbwandira F, et al. Brief report: HIV testing among pregnant women who attend antenatal care in Malawi. J Acquir Immune Defic Syndr. 2015;69(5):610.

    Article  Google Scholar 

  41. Gunn JKL, Asaolu IO, Center KE, Gibson SJ, Wightman P, Ezeanolue EE, et al. Antenatal care and uptake of HIV testing among pregnant women in sub-Saharan Africa: a cross-sectional study. J Int AIDS Soc. 2016;19(1):20605.

    Article  Google Scholar 

  42. Mahmoud MM, Nasr AM, Gassmelseed DEA, Abdalelhafiz MA, Elsheikh MA, Adam I. Knowledge and attitude toward HIV voluntary counseling and testing services among pregnant women attending an antenatal clinic in Sudan. J Med Virol. 2007;79(5):469–73.

    Article  Google Scholar 

  43. Druce P, Bogatyreva E, Siem FF, Gates S, Kaade H, Sundby J, et al. Approaches to protect and maintain health care services in armed conflict—meeting SDGs 3 and 16. Confl Heal. 2019;13(1):2.

    Article  Google Scholar 

  44. Hill PS, Pavignani E, Michael M, Murru M, Beesley ME. The “empty void” is a crowded space: health service provision at the margins of fragile and conflict affected states. Confl Heal. 2014;8(1):20.

    Article  Google Scholar 

  45. Mock NB, Duale S, Brown LF, Mathys E, O’Maonaigh HC, Abul-Husn NKL, et al. Conflict and HIV: a framework for risk assessment to prevent HIV in conflict-affected settings in Africa. Emerg Themes Epidemiol. 2004;1(1):6.

    Article  Google Scholar 

  46. Spiegel PB. HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action. Disasters. 2004;28(3):322–39.

    Article  Google Scholar 

  47. Spiegel PB, Bennedsen AR, Claass J, Bruns L, Patterson N, Yiweza D, et al. Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: a systematic review. The Lancet. 2007;369(9580):2187–95.

    Article  Google Scholar 

  48. Mills EJ, Singh S, Nelson BD. The impact of conflict on HIV/AIDS in sub-Saharan Africa. Int J STD AIDS. 2006;17(11):713–7.

    Article  Google Scholar 

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Acknowledgements

The authors thank UNICEF for the permission to use their data in this study.

Funding

No funding was received for conducting this study.

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by WM. The first draft of the manuscript was written by WM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to William Mude.

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The authors have no relevant financial or non-financial interests to disclose.

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The data used in this article utilized Multiple Indicator Cluster Survey (MICS) that was accessed via the UNICEF website upon request, which provides de-identified data. This study was reviewed and deemed exempt by our Human Research Ethics Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study by UNICEF.

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Mude, W., Nyanhanda, T. Socioeconomic Inequalities and HIV Testing During Antenatal Care in High- Medium- and Low-Conflict Intensity Countries in Sub-Saharan Africa. AIDS Behav 26, 1587–1596 (2022). https://doi.org/10.1007/s10461-021-03511-6

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