Universal screening of pregnant women for HIV vital in curbing mother to child transmission
By Anthony Idowu Ajayi
The introduction of antiretroviral drugs has resulted in a remarkable decline in mother-to-child transmission of HIV. New infections among children declined by 52% worldwide and 55% in sub-Saharan Africa between 2010 and 2019.
This is why universal screening of all pregnant women for HIV is so important. If all pregnant women were screened and treated, the risk of mother-to-child transmission could be reduced to less than 5%. Fewer than 5 000 children would be infected globally. But despite the wide availability of testing and treatment, 150 000 children were newly infected with HIV globally in 2019. The current rate of transmission is around 15%.
Sub-Saharan Africa accounts for eight out of ten new infections among children. Research suggests that new infections among children in this region have fallen from 283 000 in 2010 to 126 000 in 2019, but progress is uneven.
While most countries in southern and eastern Africa have scaled-up their prevention programmes and achieved results, the countries in west and central Africa are lagging. Some countries have even recorded an increase in mother-to-child transmission of HIV.
Uneven transmission mirrors the gaps in testing of pregnant women. For example, South Africa has reduced mother-to-child transmission to less than 4% by 2016 by ramping up testing of pregnant women and providing antiretroviral therapy. But in most west and central African countries, the rate of prenatal testing is low, and the average transmission rate is 20%.
Although there are studies that have looked at reasons why women might not test for HIV in sub-Saharan Africa, no recent studies have documented the gaps in prenatal HIV testing within and between countries.
Given this background, we examined the coverage of HIV testing among pregnant women in sub-Saharan Africa countries. The study focused on women of reproductive age. Our results confirm a huge gap between countries. Only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. Local and national governments in west and central African countries must prioritise investment in providing access to HIV testing for all pregnant women.
Local, national and international agencies should refocus efforts to promote routine HIV testing as part of all healthcare services.
With political will and adequate investment in HIV prevention programmes, mother-to-child-transmission of HIV could be eliminated.
Our research focused on whether mothers were tested for HIV as part of antenatal care. We also included individual characteristics like age, marital status, education, wealth and knowledge of HIV transmission in our statistical analysis. Our results show substantial differences between countries and sub-regions of sub-Saharan Africa in prenatal care uptake of HIV testing. While about nine out of 10 women were tested for HIV as part of antenatal care in Rwanda, South Africa, Zambia, Uganda, Burundi and Zimbabwe, only two out of 10 women were tested in Guinea, Benin and Mali. Chad has the lowest coverage, with only one in 10 women tested.
In all countries studied, except Malawi and South Africa, women who had a secondary or higher level of education were more likely to test than women who had no formal education.
Closing the gaps in coverage of HIV testing in sub-Saharan Africa will require, among other things, a massive investment in health systems in west and central Africa.
Anthony Idowu Ajayi is a Postdoctoral Research Scientist at the African Population and Health Research Centre.