Preventing HIV infection in pregnancy: a comprehensive ANC-based intervention in Western Uganda

Abstract Introduction Pregnant women in sub-Saharan Africa represent a high-risk group for HIV infection, but most endemic countries including Uganda do not engage specific HIV prevention measures in pregnancy. This longitudinal study aimed to assess outcomes of a comprehensive, ANC-embedded strategy to prevent seroconversions during pregnancy in Western Uganda. Methods HIV-negative ANC clients were administered an HIV risk assessment tool, followed by individual risk counselling. They received a fixed appointment for repeat HIV testing after three months. Those attending ANC without partners obtained formal partner invitation letters. At follow-up after three months, women not attending repeat testing were reminded via text message. Post-intervention risk behavior engagement was captured. We analyzed uptake of the intervention, HIV incidence rate, and associations with risk behavior. Results Of 1081 participants, 116 (10.7%) reported risk behavior engagement at first ANC visit, 148/1081 (13.7%) were accompanied by partners. The repeat test visit was attended by 848/1081 (78.5%) women, 42 (5.0%, p < 0.001) reported post-intervention risk behavior engagement, and 248 (29.4%, p < 0.001) were accompanied by partners. Seroconversion occurred in two women. In multivariable logistic regression, rural facility clients compared to urban ones (aOR 3.96; 95%CI 1.53-10.26), and women with positive or unknown partner HIV-status (aOR 2.86; 1.18-6.91) and partner alcohol abuse (aOR 2.68; 1.15-6.26) had increased odds for engagement in risk behavior despite the intervention. Conclusions After our intervention, risk behavior in pregnancy was reduced by half, and partner attendance had doubled compared to baseline. Our cohort showed a 0.76/100 women-years HIV incidence rate compared to 2.85 in pre-intervention data from the same setting. Clients from rural settings and women experiencing precarious partner situations require special attention to reduce risk behavior engagement during pregnancy. Key messages • HIV incidence in pregnancy in Western Uganda can be significantly reduced through a comprehensive, ANC-based counselling intervention. • Pregnant women from rural settings and those experiencing precarious partner situations require special attention regarding sexual risk behavior.


Introduction:
Pregnant women in sub-Saharan Africa represent a high-risk group for HIV infection, but most endemic countries including Uganda do not engage specific HIV prevention measures in pregnancy.This longitudinal study aimed to assess outcomes of a comprehensive, ANC-embedded strategy to prevent seroconversions during pregnancy in Western Uganda.Methods: HIV-negative ANC clients were administered an HIV risk assessment tool, followed by individual risk counselling.They received a fixed appointment for repeat HIV testing after three months.Those attending ANC without partners obtained formal partner invitation letters.At follow-up after three months, women not attending repeat testing were reminded via text message.Post-intervention risk behavior engagement was captured.We analyzed uptake of the intervention, HIV incidence rate, and associations with risk behavior.

Conclusions:
After our intervention, risk behavior in pregnancy was reduced by half, and partner attendance had doubled compared to baseline.Our cohort showed a 0.76/100 women-years HIV incidence rate compared to 2.85 in pre-intervention data from the same setting.Clients from rural settings and women experiencing precarious partner situations require special attention to reduce risk behavior engagement during pregnancy.

Key messages:
HIV incidence in pregnancy in Western Uganda can be significantly reduced through a comprehensive, ANC-based counselling intervention.Pregnant women from rural settings and those experiencing precarious partner situations require special attention regarding sexual risk behavior.
Abstract citation ID: ckac129.392Predictors of delayed vaccination in infants born in Tuscany, Italy: an area based cohort study

Background:
Timely vaccination is essential to protect infants from vaccinepreventable diseases.The aim of the study was to evaluate the determinants of vaccination timeliness for hexavalent (HEXA) and measles-mumps-rubella (MMR) vaccines.

Methods:
The study is part of the PREHMO project funded by Tuscany Region, Italy.Data on the 2017 and 2018 full birth cohorts of Tuscany (N = 41,493) were retrieved from the Birth Registry and linked to those of the Vaccine Registry up to 24 months after birth.Sociodemographic and at birth characteristics of mothers and infants were retrieved.The primary outcome was the timeliness of HEXA 1st and 3rd doses, and MMR 1st dose.Timeliness was defined as the administration of the dose a day after the period recommended by the vaccination schedule.Multiple logistic regression models were performed.

Results:
For all the vaccines considered, a significantly increased risk of delayed vaccination was observed in preterm infants and in infants born in hospital of second level of newborn care, while infants conceived by assisted reproductive technologies and first-born infants showed a significantly decreased risk for delayed vaccination.Multiple births, small for gestational age status, maternal unemployment, and rural residence were significantly associated with an increased risk of delayed HEXA-1 vaccination (OR 1.31, 95%CI 1.13-1.51;OR 1.12, 95%CI 1.03-1.22;OR 1.06, 95%CI 1.01-1.13;and OR 1.1, 95%CI 1.03-1.16).As for MMR vaccination, a low maternal education was significantly associated with high risk of delay (OR 1.12, 95%CI 1.06-1.18),while rural residence, maternal foreign nationality and female sex were significantly associated with a decreased risk of delay (OR 0.91, 95%CI 0.87-0.96;OR 0.82, 95%CI 0.78-0.87;and OR 0.95, 95%CI 0.91-0.99).

Conclusions:
Several common and vaccine-specific predictors of vaccination timeliness were identified.Strategies to improve a timely vaccination should take into account these predictors.

Key messages:
Several maternal and infants factors may influence vaccination timeliness of routine immunization in childhood.
Tailored vaccination strategies are needed to improve vaccination timeliness in infants at high-risk of delayed vaccination.
Abstract citation ID: ckac129.393An integrated care pathway for maternal and childcare: evidence from Ethiopia, Tanzania, and Uganda Ilaria Corazza Health and Management Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy Performance monitoring and evaluation are key to quality improvement in maternal and child healthcare in Sub-Saharan Africa.This study presents the experience of designing and implementing bottom-up and integrated performance evaluation tools for care pathway to monitor and manage maternity healthcare services.The research project involved four health districts and relative reference hospitals, supported by the NGO Doctors with Africa CUAMM in Ethiopia, Tanzania, and Uganda.The maternal and childcare pathway developed consists of 23 indicators, calculated at hospital and district level, relating to pregnancy, childbirth and first year of life phases.The authors developed staves and performance maps, as graphical representation tools, to display longitudinally integrated health services provision performance along the continuum of care.Substantial variation was observed between the phases of each maternal and childcare pathway and across the care pathways of the different analysed settings.The most impressive results across the four settings are: 1) regarding pregnancy phase, that women tend to attend more than four antenatal classes, still with a quite high drop-out rate, and are largely tested for syphilis, 2) with respect to childbirth, that there are varying percentage levels in terms of C-sections, episiotomies and peri/intra-partum asphyxia cases, and 3) as it regards first year of life, there emerges scope for improvement considering the vaccination coverages attained for pentavalent, measles and polio vaccinations.Thanks to the collaboration with local managers and health professionals, the maternal and childcare pathway allowed to monitor the changes in the quality of maternity services provided within the analysed contexts.The benchmarking approach encouraged local professionals to learn from other settings.The use of such tool allowed the development of targeted quality improvement actions, shared among all involved stakeholders.
15th European Public Health Conference 2022