Horizons | Research Summary| HIV Voluntary Counseling and Testing: An Essential Component in Preventing Mother-to-Child Transmission of HIV

RESEARCH SUMMARY

December 2003

HIV Voluntary Counseling and Testing:
An Essential Component in Preventing Mother-to-Child Transmission

Photo credit: Louis Apicella/Horizons

The positive results from clinical trials of the antiretroviral medications zidovudine and nevirapine created the possibility of offering an affordable and feasible intervention worldwide to reduce HIV transmission from an infected pregnant woman to her infant. Governmental and nongovernmental health services in many highly affected areas of Africa, Asia, Latin America, and Eastern Europe have responded by piloting and rapidly expanding programs for the prevention of mother-to-child HIV transmission (PMTCT.

Since their inception in 1999, programs have offered voluntary HIV counseling and testing (VCT) to more than 800,000 pregnant women around the world.¹ An important objective of VCT is to identify which pregnant women are HIV-positive so that they can receive a short course of antiretroviral drugs to prevent transmitting HIV to their infants. HIV counseling and testing also offer an opportunity to promote HIV prevention, encourage serostatus disclosure, and foster couple communication on HIV and PMTCT.

This research summary focuses on VCT in the antenatal care (ANC) setting, examining specifically service utilization by pregnant women, their perceptions of services, client outcomes as a result of undergoing HIV counseling and testing, and strategies for improving quality and coverage of VCT as a key component of PMTCT programs. The data come from a four-year intervention study conducted by Horizons, the Network of AIDS Researchers in East and Southern Africa (NARESA) in Kenya, the MTCT Working Group in Zambia, and UNICEF.

The aim of the research was to examine the introduction of a package of PMTCT services within existing maternal and child health (MCH) programs in low-resource settings. To assess the feasibility, acceptability, and impact of these interventions and to explore operational issues, the research teams in both countries collected service statistics and conducted a cohort study, using pre-intervention comparison groups for reference. In Kenya, 1,300 women at Karatina District Hospital and 800 women at Homa Bay District Hospital, as well as 1,002 women at the Chipata Clinic in Lusaka, Zambia, participated in the study. Chipata Clinic serves a densely populated, poor, peri-urban settlement in Lusaka, where service statistics show that one out of four antenatal clients is HIV-positive. At Homa Bay District Hospital, which serves a very poor area in western Kenya, HIV prevalence among antenatal clients is about 33 percent, one of the highest in Kenya. In contrast, less than 10 percent of pregnant women seen at the District Hospital in Karatina, a town in the relatively prosperous central highlands about two hours north of Nairobi, are HIV-positive.

Additional information for this summary comes from rapid assessments of PMTCT sites in 11 countries² carried out as part of a recent evaluation of United Nations-supported PMTCT pilot projects (Rutenberg et al. 2003).

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