title: High HIV incidence during pregnancy: compelling reason for repeat HIV testing.
abstract: OBJECTIVE
  To determine the incidence of HIV during pregnancy as defined by seroconversion using a repeat HIV rapid testing strategy during late pregnancy.
  
  
  METHODS
  Cross-sectional study nested in a prevention of mother-to-child transmission program
  
  
  METHODS
  Pregnant women were retested between 36 and 40 weeks of gestation, provided that they had been tested HIV negative at least 3 months prior.
  
  
  RESULTS
  Among the 2377 HIV-negative women retested, 1099 (46.2%) and 1278 (53.4%) were tested at urban and rural health facilities, respectively. Seventy-two women (3%) were HIV-positive (679 woman years of exposure) yielding a HIV incidence rate of 10.7/100 woman years [95% confidence interval (CI) 8.2-13.1]. HIV incidence in pregnancy was higher but not statistically significant at the urban facilities (12.4/100 woman years versus 9.1/100 woman years) and at least two-fold higher among the 25-29 and 30-34-year age groups (3.8 and 4.5%, respectively) as compared with the less than 20-year age group (1.9%). Single women were at 2.5 times higher risk of seroconverting during pregnancy (P = 0.017).
  
  
  CONCLUSIONS
  HIV incidence during pregnancy is four times higher than in the nonpregnant population reported in a recent survey. Public health programs need to continue to reinforce prevention strategies and HIV retesting during pregnancy. The latter also offers an additional opportunity to prevent mother-to-child transmission and further horizontal transmission. Further research is required to understand the cause of primary HIV infection in pregnancy.
authors.affiliation: Department of Obstetrics and Gynaecology, University of KwaZulu Natal, Congella, South Africa. moodleyd1@ukzn.ac.za
authors.forename: Dhayendre
authors.initials: D
authors.lastname: Moodley
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Esterhuizen
authors.forename: Thusie
authors.initials: T
authors.lastname: Pather
authors.forename: Vani
authors.initials: V
authors.lastname: Chetty
authors.forename: Linda
authors.initials: L
authors.lastname: Ngaleka
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology*; D011295:Prenatal Care / Q000379:methods; D012423:Rural Health / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult