Risk factors for HIV infection among asymptomatic pregnant women attending an antenatal clinic in western Kenya

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.

Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe

“…Strong associations between substance use and sexual risk behaviours have been reported previously and include smoking, drinking, and drug use being associated with sexual risk behaviours in general (Duncan, Strycker, & Duncan, 1999; Jackson, Sweeting, & Haw, 2012; Tu, Lou, Gao, Li, & Zabin, 2012), early sexual debut (Lowry et al, 1994), and number of sexual partners (Lowry et al, 1994; Shrier, Emans, Woods, & DuRant, 1997). Binge drinking has been associated with a higher number of partners (Guo et al, 2002), while more generally alcohol consumption has been associated with sexual debut, multiple sexual partners, and unprotected sex, all of which lead to an increased risk of HIV infection (Ayisi et al, 2000; Bassett et al, 1996; Clift et al, 2003; Lewis et al, 2005; Mnyika, Klepp, Kvale, & Ole-King’Ori, 1997; Myer, Mathews, & Little, 2002; Somsé, Chapko, & Hawkins, 1993; Zachariah et al, 2003). The increased risk of HIV infection may be attributable to the social consequences of substance use, which facilitates unprotected sex.…”

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

“…Five studies were conducted among clinic/health facility attendees, and of these two studies conducted among pregnant women found that women who currently consumed alcohol were significantly more likely to be HIV+ than those who did not (Ayisi et al, 2000;Msuya et al, 2006). In addition, one of the studies found that women whose male partners consumed…”

“…In the context of an ongoing study to determine the effect of placental malaria on mother-to-child transmission of HIV, risk factors for HIV infection among asymptomatic women attending an antenatal clinic in Kisumu, western Kenya, were identified between June 1996 and November 1997 (Ayisi et al, 2000). HIV prevalence was 26.1% among the 2 844 women included in the final analysis, and a multivariate analysis found that reported alcohol consumption was independently associated with being HIV+ (adjusted RR 1.6, 95% CI: 1.1-2.5).…”

An update on alcohol use and risk of HIV infection in sub-Saharan Africa: Meta-analysis and future research directions

“…Of the 20 studies included in Fisher and colleagues' meta-analysis, 19 were retained for inclusion in the present study (Ao, Sam, Masenga, Seage, & Kapiga, 2006;Ayisi et al, 2000;Braddick et al, 1990;Demissie, Amre, & Tsega, 1996;Fritz et al, 2002;Hargreaves et al, 2002;Kapiga, Lyamuya, Lwihula, & Hunter, 1998;Kapiga et al, 2002;Kapiga et al, 2006;Lewis et al, 2005;Mbulaiteye et al, 2000;Mnyika, Klepp, Kvåle, & Ole-King'ori, 1996;Ndina-Achola et al, 1997;Sebit et al, 2003;Simbayi et al, 2004;Talbot et al, 2002;Tengia-Kessey, Msamanga, & Moshino, 1998;Zablotska et al, 2006;Zuma, Gouws, Williams, & Lurie, 2003) and one (Gilgen, Williams, & Campbell, 2000) was excluded for failing to meet the inclusion criteria specified below (i.e., it was not published in a peer-reviewed journal). An additional eight nonoverlapping studies published prior to 2009 were identified from our previous narrative review (Allen et al, 1992;Bassett et al, 1996;Clift et al, 2003;Dunkle et al, 2004;Fisher, Cook, Sam, & Kapiga, 2008;Msuya et al, 2006;St.…”