title: Antenatal care and uptake of HIV testing among pregnant women in sub-Saharan Africa: a cross-sectional study.
abstract: BACKGROUND
  Current guidelines recommend inclusion of HIV testing in routine screening tests for all pregnant women. For this reason, antenatal care (ANC) represents a vital component of efforts to prevent mother-to-child transmission (PMTCT) of HIV. To elucidate the relationship between ANC services and HIV testing among pregnant women in sub-Saharan Africa, we undertook an analysis of data from four countries.
  
  
  METHODS
  Four countries (Congo, Mozambique, Nigeria and Uganda) were purposively selected to represent unique geographical regions of sub-Saharan Africa. Using Demographic and Health Survey datasets, weighted crude and adjusted logistic regression models were used to explore factors that influenced HIV testing as part of ANC services. The study was approved by the Institutional Review Board of the University of Arizona.
  
  
  RESULTS
  Pooled results showed that 60.7% of women received HIV testing as part of ANC. Ugandan women had the highest rate of HIV testing as part of ANC (81.5%) compared with women in Mozambique (69.4%), Nigeria (54.4%) and Congo (45.4%). Difficulty reaching a health facility was a barrier in Congo and Mozambique but not Nigeria or Uganda. HIV testing rates were lower in rural areas, among the poorest women, the least educated and those with limited knowledge of HIV. In every country, crude regression analyses showed higher odds of being tested for HIV if women received their ANC services from a skilled attendant compared with an unskilled attendant. After adjusting for confounders, women in the total sample had 1.78 (99% CI: 1.45-2.18) times the odds of having an HIV test as part of their ANC if they went to a skilled attendant compared with an unskilled attendant.
  
  
  CONCLUSIONS
  There is a need for integration of HIV testing into routine ANC service to increase opportunities for PMTCT programmes to reach HIV-positive pregnant women. Attention should be paid to the expansion of outreach services for women in rural settings, and to the training, supervision and integration of unskilled attendants into formal maternal and child health programmes. Education of pregnant women and their communities is needed to increase HIV knowledge and reduce HIV stigma.
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Jayleen K L
authors.initials: JK
authors.lastname: Gunn
authors.affiliation: Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Ibitola O
authors.initials: IO
authors.lastname: Asaolu
authors.affiliation: Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Center
authors.affiliation: University of Arizona Cancer Center, Tucson, AZ, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Gibson
authors.affiliation: Center for Population Health, Arizona Health Sciences Center (AHSC), Center for Population Science and Discovery, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Wightman
authors.affiliation: Global Health and Implementation Research Initiative, Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
authors.forename: Echezona E
authors.initials: EE
authors.lastname: Ezeanolue
authors.affiliation: Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA; jehiri@email.arizona.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Ehiri
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011295:Prenatal Care
keywords: Antenatal care; HIV testing; MTCT; PMTCT; global health; global maternal and child health; low-income countries; maternal and child health; prenatal care; sub-Saharan Africa