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High HIV incidence during pregnancy: compelling reason for repeat HIV testing

Moodley, Dhayendrea; Esterhuizen, Tonya Mb; Pather, Thusiea; Chetty, Vania; Ngaleka, Lindaa

doi: 10.1097/QAD.0b013e32832a5934
Clinical Science: Concise Communication

Objective: To determine the incidence of HIV during pregnancy as defined by seroconversion using a repeat HIV rapid testing strategy during late pregnancy.

Design: Cross-sectional study nested in a prevention of mother-to-child transmission program

Methods: Pregnant women were retested between 36 and 40 weeks of gestation, provided that they had been tested HIV negative at least 3 months prior.

Results: Among the 2377 HIV-negative women retested, 1099 (46.2%) and 1278 (53.4%) were tested at urban and rural health facilities, respectively. Seventy-two women (3%) were HIV-positive (679 woman years of exposure) yielding a HIV incidence rate of 10.7/100 woman years [95% confidence interval (CI) 8.2–13.1]. HIV incidence in pregnancy was higher but not statistically significant at the urban facilities (12.4/100 woman years versus 9.1/100 woman years) and at least two-fold higher among the 25–29 and 30–34-year age groups (3.8 and 4.5%, respectively) as compared with the less than 20-year age group (1.9%). Single women were at 2.5 times higher risk of seroconverting during pregnancy (P = 0.017).

Conclusion: HIV incidence during pregnancy is four times higher than in the nonpregnant population reported in a recent survey. Public health programs need to continue to reinforce prevention strategies and HIV retesting during pregnancy. The latter also offers an additional opportunity to prevent mother-to-child transmission and further horizontal transmission. Further research is required to understand the cause of primary HIV infection in pregnancy.

Author Information

aDepartment of Obstetrics and Gynaecology, Women's Health and HIV Research Unit, South Africa

bProgramme of Biostatistics, Research Ethics and Medical Law, College of Health Sciences, University of KwaZulu Natal, Congella, South Africa.

Received 24 August, 2008

Revised 2 February, 2009

Accepted 13 February, 2009

Correspondence to Dhayendre Moodley, PhD, Associate Professor, Department of Obstetrics and Gynaecology, Women's Health and HIV Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Private Bag 7, Congella 4013, South Africa. Tel: +27 31 2604684; fax: +27 31 2604753; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.