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  • Title: Risk factors for HIV infection among asymptomatic pregnant women attending an antenatal clinic in western Kenya.
    Author: Ayisi JG, van Eijk AM, ter Kuile FO, Kolczak MS, Otieno JA, Misore AO, Kager PA, Steketee RW, Nahlen BL.
    Journal: Int J STD AIDS; 2000 Jun; 11(6):393-401. PubMed ID: 10872913.
    Abstract:
    Our objective was to evaluate HIV prevalence and identify risk factors for HIV infection among women attending the antenatal clinic (ANC) at a large public hospital in Kisumu town, western Kenya. Between June 1996 and November 1997, in the context of a study to determine the effect of placental malaria on mother-to-child transmission of HIV in western Kenya, HIV-1 antibody testing was offered to women with a singleton uncomplicated pregnancy of > or =32 weeks' gestation attending the ANC. Women were interviewed using a structured questionnaire and had a fingerstick blood sample collected for haemoglobin (Hb), malaria smears, and HIV antibody testing. Overall HIV seroprevalence was 26.1% (743/2844) (95% confidence interval (CI): 24.5-27.7) and in bivariate evaluation was significantly associated with anaemia (Hb <11 g/dl) (risk ratio (RR) 1.8), malarial parasitaemia (RR 1.6), fever (axillary temperature > or =37.5 degrees C at screening) (RR 1.6), a history of being treated for either vaginal discharge (RR 1.5) or tuberculosis (RR 1.6), reported alcohol consumption (RR 1.6), being an unmarried multigravida (RR 2.2) or a history of the most recent child having died (RR 2.0). Poisson regression analysis for all women identified 5 significant factors independently associated with HIV seropositivity: anaemia (adjusted RR 1.7; 95% CI 1.3-2.0), malarial parasitaemia (adjusted RR 1.7; 95% CI 1.4-2.0), a history of being treated for vaginal discharge (adjusted RR 1.5; 95% CI 1.1-2.0), fever (adjusted RR 2.0; 95% CI 1.3-3.2) and reported alcohol consumption (adjusted RR 1.6; 95% CI 1.1-2.5). Multigravidae women whose most recent child had died were also more likely to be HIV seropositive (adjusted RR 1.9; 95% CI 1.7-2.8). Only 5.5% (156/2844) of the women had none of these risk factors, of whom 12% (18/156) were HIV(+). Even though the model containing the 5 identified factors fitted the data well (goodness-of-fit chi2=18.41, P=0.10), its collective capacity to predict HIV infection was poor; while 74% of the truly positive women were correctly predicted positive by the model, 52% of the truly negative women were misclassified. Among pregnant women attending the ANC in western Kenya, we were unable to identify a subgroup at risk of HIV infection using non-serological information, indicating that wherever possible universal access to voluntary HIV counselling and testing would be preferable to targeted screening. This study evaluated the HIV prevalence and identified the risk factors for HIV infection among women attending the antenatal clinic at a public hospital in Kisumu, western Kenya. Also, the effect of placental malaria on vertical HIV transmission were determined using structured interviews and HIV-1 antibody testing and hemoglobin malaria smears were offered to the respondents. Overall, HIV seroprevalence was 26.1% (743/2844) (95% confidence interval [CI]: 24.5-27.7) and in bivariate evaluation was significantly associated with anemia (risk ratio [RR] 1.8), malarial parasitemia (RR 1.6), fever (RR 1.6), a history of being treated for either vaginal discharge (RR 1.5) or tuberculosis (RR 1.6), alcohol consumption (RR 1.6), being an unmarried multigravida (RR 2.2), or a history of the most recent child having died (RR 2.0). Using the Poisson regression analysis, 5 significant factors associated with HIV seropositivity were identified: anemia, malarial parasitemia, and history of being treated for vaginal discharge, fever, and reported alcohol consumption. Among the pregnant women, the researchers were unable to identify a subgroup at risk of HIV infection using nonserological information, indicating that universal access to voluntary HIV counseling and testing would be preferable to targeted screening.
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