Time trends in management of HIV-positive pregnant women in Northern Tanzania: A registry-based study

Abstract

Objective: To examine time trends in antenatal factors and delivery characteristics in Northern Tanzania, and relate these to national guidelines for HIV in pregnancy.

Design: Registry-based study.

Setting: Northern Tanzania, 2000-2014.

Population or sample: Deliveries (n = 33 346).

Methods: HIV-positive women were compared with HIV-negative women during four periods spanning changing national guidelines.

Main outcome measures: Known maternal HIV status, HIV treatment for woman, number of antenatal care (ANC) visits, routine folate/iron in pregnancy, anemia, delivery complications/interventions.

Results: We observed an increase in deliveries with known maternal HIV status and women receiving HIV treatment, and a decline in deliveries with positive maternal HIV status (p-values for trend <0.001). The proportion of women with less than four ANC visits increased to above 30 percent irrespective of HIV status. Use of routine folate/iron increased, corresponding to a decrease in anemia which was strongest in HIV-negative women. Incidence of elective caesarean section (CS) and emergency CS remained unchanged for HIV-positive women (7.1% and 25.5%, respectively, in the last period). Use of invasive procedures declined in both groups of women. Mothers who were young, single, had low education, high parity or lived in the rural area more often had indicators of poor antenatal care.

Conclusions: Increasing adherence to national guidelines over time was found for most selected outcomes. Still, a high occurrence of insufficient ANC, anemia and emergency CS call for efforts to explore and identify barriers that hinder optimal care.

Fig 1

Percentage of deliveries with known maternal HIV status (left panel). Percentage of deliveries with HIV-positive mother. Denominators are deliveries with known maternal HIV status (right panel).

Fig 2. Antenatal factors and delivery characteristics among HIV-positive and HIV-negative pregnant women in Northern Tanzania by time period₁.

Forest plot shows relative risks in each time period, HIV-positive women compared with HIV-negative women. (Adjusted for maternal age, marital status, parity, current residence and education level.) P-values in plot are for trends in ARR. ₁ Time periods: 2000–2003: Pilot phase before national PMTCT guidelines; 2004–2006: WHO 2004 guidelines; 2007–2011: Revised WHO 2004 guidelines; 2012–2014: WHO Option A guidelines. ₂ Missing observations: Referred for delivery (3.8%), anemia (38.7%). Other variables <2% missing observations.