Date of Award

January 2020

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sten H. Vermund

Abstract

Background

To validate Elimination of Mother to Child HIV Transmission (eMTCT), pregnant women must receive antenatal care (ANC) HIV testing. Given challenges for adolescent girls in ANC, we hypothesized that adolescents were less likely to receive ANC HIV testing in Eastern and Southern Africa (ESA).

Methods

For 10 ESA countries, we use 2015-2018 Demographic and Health Surveys (DHS) to study 46,056 women attending ANC and giving birth in the last three years. We used age-stratified (15-19, 20-24, and 25-49 years of age at time of delivery) crude and adjusted logistic regressions to assess predictive factors for ANC HIV testing, both by country and pooled across countries. Variables were selected for logistic regression if statistically significant (<0.05 level, two-tailed) in the literature or in our crude odds analysis. We also assessed the association between adolescence (15-19 years) and ANC HIV testing, examining confounding and interacting effects.

Results

In the pooled analysis, adolescents were less likely to receive ANC HIV testing (aOR=0.84, p=0.03) than women 20-49. Two individual countries had significant associations: more likely tested in South Africa (aOR = 1.93, p=0.04) and less likely in Uganda (aOR = 0.61, p<0.01). Factors independently associated with increased odds of testing for women regardless of age were knowledge of MTCT, at least four ANC visits, being employed, and first pregnancy. In at least one country, risk factors significantly associated with decreased odds of testing regardless of age were rural location, poverty, unplanned pregnancy, and holding discriminatory attitudes towards persons living with HIV. The pooled effect of relationship status differed by age group; women 15-19 were less likely (aOR = 0.70, p<0.01) to be tested if they were in a couple, whereas older women were more likely to be tested if they were in a couple (20-24 aOR=1.07 p=0.44, 25-49 aOR=1.34 p<0.01).

Conclusion

Adolescent age predicts lower ANC HIV testing, although there was variation between countries. Special efforts are needed to engage adolescents in eMTCT. We do not know why adolescents in couples were less likely to be tested, the opposite of what was seen in older women.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/27/2021

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