Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study

• Published in: PloS one Vol. 13; no. 8; p. e0199819
• Main Authors: Rasmussen, Dlama Nggida, Unger, Holger Werner, Bjerregaard-Andersen, Morten, da Silva Té, David, Vieira, Noel, Oliveira, Inés, Hønge, Bo Langhoff, Jespersen, Sanne, Gomes, Margarida Alfredo, Aaby, Peter, Wejse, Christian, Sodemann, Morten
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.08.2018; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Analysis; Antiretroviral drugs; Biology and Life Sciences; Care and treatment; Cross-sectional studies; Disease transmission; Forecasts and trends; Health; HIV; HIV tests; Human immunodeficiency virus; Instability; Management systems; Medicine and Health Sciences; Morbidity; Mortality; Mother-child relations; People and places; Poisson density functions; Political factors; Politics; Pregnancy; Prevention; Regression analysis; Regression models; Statistical analysis; Womens health; Guinea-Bissau; United Kingdom > UK; Guinea Bissau; West Africa; Africa; Denmark; England; Scotland; Edinburgh Scotland; Aarhus Denmark
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0199819

The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson's χ2 test. Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73-1.84), as was a lower educational status (APR 1.05; 95% CI 1.00-1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01-1.09) and on Sundays (APR 1.14; 95% CI 1.07-1.22) and Mondays (APR 1.12; 95% CI 1.05-1.19). Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.