HIV retesting for pregnant and breastfeeding women across maternal child health services in Nampula, Mozambique

PLOS ONE RESEARCH ARTICLE HIV retesting for pregnant and breastfeeding women across maternal child health services in Nampula, Mozambique Chloe A. Teasdale ID1,2,3*, Michelle Choy3, Fatima Tsiouris ID3, Eduarda Pimentel De Gusmao3, Etelvino C. P. Banqueiro3, Aleny Couto4, Kwalila Tibana4, Nicole Flowers ID5, Marilena Urso6, Mirriah Vitale3, Elaine J. Abrams2,3,7 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America, 2 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America, 3 ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America, 4 Ministério da Saúde de Moçambique, Maputo, Mozambique, 5 US Centers for Disease Control and Prevention, Atlanta, GA, United States of America, 6 US Centers for Disease Control and Prevention, Maputo, Mozambique, 7 Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America * OPEN ACCESS Citation: Teasdale CA, Choy M, Tsiouris F, De Gusmao EP, Banqueiro ECP, Couto A, et al. (2023) HIV retesting for pregnant and breastfeeding women across maternal child health services in Nampula, Mozambique. PLoS ONE 18(3): e0283558. https://doi.org/10.1371/journal. pone.0283558 Editor: Isabelle Chemin, Centre de Recherche en Cancerologie de Lyon, FRANCE Abstract Background Repeat HIV testing during pregnancy and breastfeeding identifies women with incident infections, those living with HIV who have been lost to care, and infants at risk for HIV infection. We report data from repeat testing for women in maternal and child health (MCH) services at 10 health facilities in Mozambique. Received: October 20, 2022 Accepted: March 10, 2023 Methods Published: March 24, 2023 Routinely collected data from health facility registers are reported from April-November 2019. From antenatal care (ANC), we report numbers and proportions of women eligible for retesting; returned for care when retesting eligible; retested; and HIV-positive (HIV+) at retesting. From child welfare clinics (CWC), we report mothers retested; tested HIV-positive; HIV+ mothers linked to ART services; HIV-exposed infants (HEI) tested for HIV with polymerase chain reaction (PCR) tests; HEI testing PCR positive; PCR-positive infants linked to care. Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data Availability Statement: The data used for this analysis are the property of the government of Mozambique and as such cannot be made publicly available. Requests for data can be sent to ICAP at Columbia University - icap-research@cuimc. columbia.edu. Funding: This work was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Results In ANC, 28,233 pregnant women tested HIV-negative at first ANC visit, 40.7% had a followup visit when retesting eligible, among whom 84.8% were retested and 0.3%(N = 26) tested HIV+. In CWC, 26,503 women were tested; 0.8%(N = 212) tested HIV+ and 74.1%(N = 157) of HIV+ women were linked to care. Among 157 HEI identified in CWC, 68.4%(N = 145) received PCR testing and 19.3%(N = 28) tested positive. PLOS ONE | https://doi.org/10.1371/journal.pone.0283558 March 24, 2023 1 / 12 PLOS ONE Cooperative Agreement Numbers U2GGH000994. https://www.cdc.gov/ None of the authors were recipient of the award that funded the work however the following authors were partially funded by the grant to conduct the project described in the manuscript: CAT, MC, FT, EPG, EB, MV, EJA CDC employees (NF and MU) were involved in the design of the project, decision to publish and preparation of the manuscript but were not involved in the collection or analysis of data. HIV retesting in pregnancy and breastfeeding Conclusion In ANC, less than half of pregnant women eligible for retesting returned for follow-up visits, and test positivity was low among women retested in ANC and CWC. In CWC, linkage to infant testing was poor and almost 20% of HEI were PCR-positive. Implementing retesting for pregnant and breastfeeding women is challenging due to high numbers of women and low testing yield. Competing interests: The authors have declared that no competing interests exist. Abbreviations: ANC, Antenatal care; ART, Antiretroviral therapy; CWC, Child Welfare Clinics; HEI, HIV-exposed infant; MCH, maternal child health; PMTCT, Prevention of mother-to-child transmission; PRC, polymerase chain reaction; WLHIV, women living with HIV; CDC, US Centers for Disease Control and Prevention; WHO, World Health Organization. Background Identifying pregnant women living with HIV (WLHIV) and initiating them on antiretroviral therapy (ART) is critical for maintaining their health and decreasing the risk of vertical transmission [1]. Expansion of HIV testing for all pregnant women at the first antenatal care (ANC) visit with immediate ART initiation has led to significant reductions in new pediatric HIV infections [2]. In 2010 across UNAID’s 21 focus countries (those with the largest populations of pregnant WLHIV), less than half of all pregnant WLHIV received ART and there were more than 250,000 new pediatric infections, whereas in 2020, 85% of pregnant women received ART and approximately 110,000 children newly acquired HIV [2]. Despite high coverage of HIV testing and ART among pregnant women there are still many children newly acquiring HIV each year [1, 3, 4]. There are several factors driving vertical transmission of HIV, including poor retention of WLHIV in care and on ART [5]. Loss to follow-up from prevention of mother-to-child transmission (PMTCT) and ART services during pregnancy and in the postnatal period increases the risk of vertical transmission and compromises women’s health [2]. It is estimated that almost a third of women in high HIV burden countries who initiate treatment during pregnancy are not retained by 6 months [5]. In addition, incident HIV infections occurring during pregnancy and in the postnatal period are contributing to an increasing proportion of new pediatric HIV infections [2, 6]. When women newly acquire infection during pregnancy or breastfeeding, there is higher risk of vertical transmission [7] and these women are often missed for interventions, including ART initiation, infant postnatal prophylaxis and early infant diagnosis (EID) [8]. The World Health Organization (WHO) recommends repeat HIV testing for pregnant and postpartum women in countries with generalized HIV epidemics to identify women with inci (...truncated)