title: Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India.
abstract: BACKGROUND
  Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.
  
  
  METHODS
  Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.
  
  
  RESULTS
  The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age ≥ 25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).
  
  
  CONCLUSIONS
  Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.
authors.affiliation: St John's Research Institute, Bangalore, 560034, India; CHARME II Project, Bangalore, 560044, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Thamattoor
authors.affiliation: St John's Research Institute, Bangalore, 560034, India; CHARME II Project, Bangalore, 560044, India.
authors.forename: Tinku
authors.initials: T
authors.lastname: Thomas
authors.affiliation: CHARME II Project, Bangalore, 560044, India; Department of Epidemiology, National Institute of Medical Sciences (NIMHANS), Bangalore, 560029, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Banandur
authors.affiliation: CHARME II Project, Bangalore, 560044, India; Karnataka Health Promotion Trust, Bangalore, 560044, India.
authors.forename: S
authors.initials: S
authors.lastname: Rajaram
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada; Département de mathématiques et de statistique, Université Laval, Québec, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Duchesne
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors.forename: Belkacem
authors.initials: B
authors.lastname: Abdous
authors.affiliation: St John's Research Institute, Bangalore, 560034, India; Karnataka Health Promotion Trust, Bangalore, 560044, India.
authors.forename: Reynold
authors.initials: R
authors.lastname: Washington
authors.affiliation: CHARME II Project, Bangalore, 560044, India; Karnataka Health Promotion Trust, Bangalore, 560044, India.
authors.forename: B M
authors.initials: BM
authors.lastname: Ramesh
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.affiliation: CHARME II Project, Bangalore, 560044, India; Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D055361:Multilevel Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D018571:Sentinel Surveillance; D060386:Sex Workers; D055815:Young Adult