HIV retesting uptake and incidence during pregnancy and breastfeeding period among women in sub-Saharan Africa

Abstract

To prevent and reduce mother-to-child transmission of HIV and maternal morbidity and mortality, the World Health Organization currently requires retesting for HIV during pregnancy and postpartum. This was a systematic review and meta-analysis in which PubMed, Cochrane Library, Embase, and clinicaltrials.gov were searched for articles published between January 2005 and February 2024. Retesting uptake was defined as the number of women who tested for HIV during pregnancy/breastfeeding periods following an initial HIV-negative test during these periods. Using random-effects models, we computed the pooled prevalence of HIV retesting uptake, incidence rates (IRs), and 95% confidence intervals (CIs). A sensitivity analysis was done by excluding studies that tested women during labor and reported 100% retesting uptake. A total of 37 studies with 1,999,621 women were analyzed. Overall, the pooled prevalence of HIV retesting uptake was 89.1% (95%CI, 81.0-95.2). Retesting uptake was significantly higher during breastfeeding compared to pregnancy (93.3% vs. 89.9%; P < 0.001). A sensitivity analysis showed that overall retesting uptake was 73.9% (95%CI, 60.1-83.8). A total of 1302 (0.2%) women acquired HIV. Twenty-two studies reported an IR; the overall pooled IR was 4.3/100 person-year (PY; 95%CI, 3.4-5.2/100 PY). The HIV incidence rate was significantly higher during pregnancy compared to breastfeeding (5.9/100 vs. 3.4/100 PY; P < 0.001). One to three in 10 women in sub-Saharan Africa do not retest for HIV following a negative test during pregnancy or breastfeeding periods. Emphasizing HIV retesting during these periods is critical to eliminate pediatric HIV given that the overall IR is beyond the WHO threshold (3.0/100 PY) for a substantial risk of HIV transmission.

Keywords: HIV incidence; HIV testing uptake; postpartum; pregnancy; sub-Saharan Africa.