title: High rates of HIV seroconversion in pregnant women and low reported levels of HIV testing among male partners in Southern Mozambique: results from a mixed methods study.
abstract: BACKGROUND
  Prevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV. Identification and support for HIV negative pregnant women and their partners, particularly serodiscordant couples, are critical. A mixed method study done in Southern Mozambique estimated HIV incidence during pregnancy, associated risk factors and factors influencing partner's HIV testing.
  
  
  METHODS
  Between April 2008 and November 2011, a prospective cohort of 1230 HIV negative pregnant women was followed during pregnancy. A structured questionnaire, HIV testing, and collection of dried blood spots were done at 2-3 scheduled visits. HIV incidence rates were calculated by repeat HIV testing and risk factors assessed by Poisson regression. A qualitative study including 37 individual interviews with men, women, and nurses and 11 focus group discussions (n = 94) with men, women and grandmothers explored motivators and barriers to uptake of male HIV testing.
  
  
  RESULTS
  HIV incidence rate was estimated at 4.28/100 women-years (95%CI: 2.33-7.16). Significant risk factors for HIV acquisition were early sexual debut (RR 3.79, 95%CI: 1.04-13.78, p = 0.04) and living in Maputo Province (RR 4.35, 95%CI: 0.97-19.45, p = 0.05). Nineteen percent of women reported that their partner had tested for HIV (93% knew the result with 8/213 indicating an HIV positive partner), 56% said their partner had not tested and 19% did not know their partner test status. Of the 14 seroconversions, only one reported being in a serodiscordant relationship. Fear of discrimination or stigma was reported as a key barrier to male HIV testing, while knowing the importance of getting tested and receiving care was the main motivator.
  
  
  CONCLUSIONS
  HIV incidence during pregnancy is high in Southern Mozambique, but knowledge of partners' HIV status remains low. Knowledge of both partners' HIV status is critical for maximal effectiveness of prevention and treatment services to reach elimination of pediatric HIV/AIDS.
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique.
authors.forename: Caroline
authors.initials: C
authors.lastname: De Schacht
authors.affiliation: The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, D.C., United States of America.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Hoffman
authors.affiliation: Instituto Nacional de Saúde, Maputo, Mozambique.
authors.forename: Nédio
authors.initials: N
authors.lastname: Mabunda
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique.
authors.forename: Carlota
authors.initials: C
authors.lastname: Lucas
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique; Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Washington, D.C., United States of America.
authors.forename: Catharina L
authors.initials: CL
authors.lastname: Alons
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique.
authors.forename: Ana
authors.initials: A
authors.lastname: Madonela
authors.affiliation: Instituto Nacional de Saúde, Maputo, Mozambique.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Vubil
authors.affiliation: Federal University of Rio de Janeiro, Biology Institute, Rio de Janeiro, Brazil.
authors.forename: Orlando C
authors.initials: OC
authors.lastname: Ferreira
authors.affiliation: Ministry of Health, Xai-Xai, Mozambique.
authors.forename: Nurbai
authors.initials: N
authors.lastname: Calú
authors.affiliation: Ministry of Health, Matola, Mozambique.
authors.forename: Iolanda S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Instituto Nacional de Saúde, Maputo, Mozambique.
authors.forename: Ilesh V
authors.initials: IV
authors.lastname: Jani
authors.affiliation: The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, D.C., United States of America; Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Washington, D.C., United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Guay
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012747:Sexual Partners; D055815:Young Adult