HIV risk perception and prevalence in a program for prevention of mother-to-child HIV transmission: comparison of women who accept voluntary counseling and testing and those tested anonymously.
OBJECTIVE
To determine whether data from voluntary counseling and testing (VCT)/prevention of mother-to-child transmission (PMTCT) programs can be used for HIV surveillance.


METHODS
Women attending an antenatal clinic at the district hospital in Entebbe, Uganda, from May 2002 to April 2003 were offered counseling and HIV testing with same-day results (VCT) and nevirapine for PMTCT was provided for HIV-positive women and their babies. Those who declined VCT were tested for HIV anonymously.


RESULTS
Overall, 2635 women accepted VCT; 883 were tested anonymously. HIV prevalence was higher in VCT than in anonymously tested women in the first month of the program (20% vs. 11%, P=0.05) and in months with <70% VCT uptake (17% vs. 8%, P<0.001) but was similar in months with high uptake. Uptake of VCT was higher in women who had risk factors for HIV, especially those who believed themselves to have been exposed (84% vs. 73%, P<0.001).


CONCLUSIONS
There was a bias to accepting VCT in women with HIV, or risk factors for HIV infection, the former most apparent when there was low coverage. Data from VCT/PMTCT programs cannot replace anonymous surveillance for monitoring of HIV epidemic trends where coverage is incomplete within clinics or communities.
Uganda Virus Research Institute and Entebbe General Hospital, Entebbe, Uganda.
Harriet
H
Mpairwe
Lawrence
L
Muhangi
Proscovia B
PB
Namujju
Andrew
A
Kisitu
Alex
A
Tumusiime
Moses
M
Muwanga
James A G
JA
Whitworth
Saul
S
Onyango
Benon
B
Biryahwaho
Alison M
AM
Elliott
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D035041:Anonymous Testing; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control* / Q000635:transmission*; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D009313:National Health Programs; D010342:Patient Acceptance of Health Care; D010465:Perception; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012309:Risk-Taking; D014454:Uganda / Q000453:epidemiology