Uptake and determinants for HIV postpartum re-testing among mothers with prenatal negative status in Njombe region, Tanzania

Abstract

Background: Uptake of Human Immunodeficiency Virus (HIV) re-testing among postnatal mothers who had previously tested HIV-negative is crucial for the detection of recent seroconverters who are likely to have high plasma viral loads and an increased risk of mother-to-child HIV transmission. Tanzania set a target of 90% re-testing of pregnant mothers who had tested negative during the first test. However, there is no statistics on the implementation, coverage and the factors determining re-testing among pregnant women in Tanzania. This study determined the proportion of newly-delivered, previously HIV-negative mothers who returned for HIV re-testing, and assessed the determinants of re-testing in Njombe Region in Tanzania. Methods: A cross-sectional study was conducted in four health facilities in Njombe and Wanging'ombe districts during December 2015-June 2016. All newly-delivered mothers (≤7 days from delivery) presenting at health facilities and who had previously tested HIV-negative during pregnancy were included. A structured questionnaire was used to collect data on the determinants for re-testing. Records on the previous HIV testing was verified using antenatal clinic card. A multiple logistic regression model was used to calculate the adjusted odds ratio (AOR) with their 95% confidence intervals (CI) to quantify the association. Results: Of 668 mothers (median age = 25 years) enrolled, 203 (30.4%) were re-tested for their HIV status. Among these, 27 (13.3%) tested positive. Significant predictors for HIV re-testing were socio-demographic factors including having at least a secondary education [AOR = 1.9, 95% CI: 1.25-3.02] and being employed [AOR = 2.1, 95% CI: 1.06-4.34]; personal and behavioural factors, reporting symptoms of sexually transmitted infections [AOR = 4.9, 95% CI: 2.15-6.14] and use of condoms during intercourse [AOR = 1.7, 95% CI: 1.13-2.71]. Significant health system factors were having ≥4 ANC visits [AOR = 1.8, 95% CI: 1.21-2.69] and perceiving good quality of HIV counselling and testing service at the first ANC visit [AOR = 2.14, 95% CI: 1.53-3.04]. Conclusion: Uptake of the HIV re-testing was lower than the national target. Education level, employment status, having ≥4 ANC visits, reporting sexually-transmitted infections, condom use, and good perception of HIV tests were significant factors increased uptake for re-testing. Identified factors should be incorporated in the Prevention of the Mother-to-Child Transmission (PMTCT) programme strategies to prevent HIV infection in new-borns.