Missed Signals: Not Investigating High HIV Incidence in Pregnant Women in Africa
21 Pages Posted: 17 Apr 2018
Date Written: March 31, 2018
Introduction: One way to find and stop HIV transmission through healthcare is to investigate unexplained infections. Because pregnant women in Africa get a lot of healthcare and HIV tests, public health officials should be alert to recognize and investigate new infections in pregnant and early postpartum women with no sexual risks.
Methods: For all identified published reports of HIV incidence (new infections) in pregnant and early postpartum women in Africa, I look for evidence of nosocomial (from healthcare) infections in two ways: reported incidence higher than estimated incidence from sex (calculated from estimates of partners’ HIV prevalence, coital frequency, and transmission per coital act); and reported incidence so high that women with incidence at that rate for several years would reach observed prevalence in the population from which the sample or cohort was selected.
Results: In 46 samples or cohorts, HIV incidence in pregnant and early postpartum women ranges from 0 to 19 per 100 person-years (PYs). After subtracting estimated incidence from sex, unexplained incidence in 14 samples or cohorts ranges from 5.8 to 14.9 per 100 PYs. For 10 of the 14 reports of unexplained incidence ≥5.8 per 100 years, studies report HIV prevalence in the population of women from which the sample or cohort was selected; in all 10 studies, women acquiring HIV at the observed rate would reach observed HIV prevalence in 0.9-3.9 years.
Discussion: Unexplained high incidence in pregnant and early postpartum women in some sites and years suggests many may have gotten HIV from pregnancy-related healthcare. Initiatives to protect women (e.g., reporting infection control practices in pregnancy-related healthcare, acknowledging unexplained infections, and investigating suspected outbreaks) are indicated.
Keywords: Women, Nosocomial, Pregnancy, Iatrogenic, Africa, HIV
JEL Classification: I118
Suggested Citation: Suggested Citation