Uptake and determinants of HIV retesting among postnatal mothers attending private health facilities in Dar es salaam region, Tanzania

Abstract

ABSTRACT Background: HIV retesting in late pregnancy is crucial to identify and initiate long life ARV for pregnant women who might be in the window period to prevent mother to child transmission of HIV and keeping their mothers alive. Tanzania National guideline recommends that all pregnant women and their partners should be tested and counseled for HIV during their first ANC visit, among those HIV negative they should be retested for HIV during the third trimester, during labor or at delivery. Objective: The study aimed to determine the uptake and determinants of HIV retesting among postnatal mothers previously negative for HIV at initial antenatal clinic HIV testing in private health facilities. Methods: Facility-based cross-sectional study was conducted from May to July 2018 after approval by the institutional review committee of MUHAS. A total of 395 postnatal mothers who delivered within seven days prior to the study period participated in the study. Only mothers who had negative HIV testing results at initial ANC HIV testing earlier in the index pregnancy were involved. They included those who delivered during the study period and those who delivered in the past seven days prior to the study. One to one structured questions were used for interviewing respondent. Informed consent was sought from all participants before the interview. Data were cleaned and entered into EPIDATA then be analyzed by SPSS version 20. Chi square was used to test for association between categorical variables and outcome variables of retesting. All variables with p value of ≤ 0.2 in bivariate analysis were included in the multivariate logistic regression model to control for confounders where odds ratios and their 95% CI were used to assess statistical significance and strength of association. Cut-off for statistical significance level was set at p value of ≤ 0.05. Results: This study found low uptake of HIV retesting among postnatal mothers. Of 395 mothers enrolled in the study, 227 (57.5%) were retested for HIV. Among those retested, 7 (3.1%) found to be HIV positive in a repeat test. Variables independently statistically associated with retesting were ANC booking after 24 weeks (AOR-=.17, 95% CI 0.07, 0.39, p-value 0.0001), parity of more than 3 live children AOR= 0.15 95% CI 0.03, 0.62, p value 0.01. ANC attendance of 4 or more visit (AOR 2.18, 95% CI 1.23, 3.89, p value 0.01), Perceived suboptimum quality of counseling (AOR 1.87, 1.18, 2.94, p value 0.01) and those perceived high stigma level (AOR= 0.45, 95% CI 0.29,0.71 p value 0.001) Conclusion: Uptake of HIV retesting among postnatal mothers was associated with high stigma level, parity of more than three children, ANC attendance of 4 or more visit suboptimal counseling and late booking at ANC after 24 weeks. Recommendation: Strengthen health education and sensitization to mothers in all areas, on the importance and benefits of HIV retesting.