title: Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia.
abstract: OBJECTIVE
  To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence.
  
  
  METHODS
  A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form.
  
  
  RESULTS
  Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery.
  
  
  CONCLUSIONS
  Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting.
authors.affiliation: Department of Obstetrics, Saint Francis Hospital, Katete, Zambia.
authors.forename: Steffie
authors.initials: S
authors.lastname: Heemelaar
authors.forename: Nicole
authors.initials: N
authors.lastname: Habets
authors.forename: Ziche
authors.initials: Z
authors.lastname: Makukula
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: Thomas
authors.initials: T
authors.lastname: van den Akker
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis*; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012424:Rural Population; D055815:Young Adult; D015024:Zambia
keywords: HIV; VIH; calidad de cuidados; cuidados prenatales; embarazo; grossesse; maternal and child health; pregnancy; prenatal care; quality of care; qualité des soins; salud materno-infantil; santé maternelle et de l'enfant; soins prénatals