Repeat HIV Testing And Seroconversion During Pregnancy In The Context Of Prevention Of Mother-To-Child Transmission Of HIV In Sub-Saharan Africa: Systematic Review And Meta-Analysis

Abstract

Background: Pregnant women may consistently be at risk of acquiring HIV infection during pregnancy. In sub-Saharan Africa where the prevalence of HIV is high, this only presents implications on vertical transmission of the virus during this critical period. Detecting seroconversions that occur during pregnancy is critical to preventing vertical transmission thus the need for repeat HIV testing. The objective of this systematic review and meta-analysis was to estimate the proportion of repeat HIV testing and the incidence rate of HIV seroconversions detected as a result. The review also sought to compare the risk of MTCT during pregnancy in seroconverted pregnant women receiving ART to seroconverted pregnant women naïve of ART. Methods: PubMed, Cochrane Central, HINARI, Google Scholar and African Journals Online databases were searched between January 2007 and 10th October 2020 for articles and abstracts reporting on repeat HIV testing and seroconversion during pregnancy in any sub-Saharan African Country. The eligibility criteria were studies conducted in sub-Sahara Africa with data on the conduction of repeat HIV testing during pregnancy. Random effects models were constructed to pool the proportion of repeat HIV testing and the incidence rate of seroconversion during pregnancy. 1725 studies were identified, out of which 22 studies met the inclusion criteria and contributed data for the meta-analysis. Results: The pooled proportion of repeat HIV testing during pregnancy in sub-Saharan Africa was estimated at 78.4% (CI: 66.7% to 90.1%) with Western Africa having the highest pooled estimate of 90.8% (95% CI: 72.7% to 100%). The pooled cumulative incidence of HIV seroconversion during pregnancy detected through repeat HIV testing was 1.5% (95% CI: 0.9% to 2.1%) the pooled incidence rate of seroconversion during pregnancy pegged at 3.9 per 100 person years (95% CI: 1.4 to 6.5 per 100 person years). In the only one study that assessed vertical transmission in women who seroconverted during pregnancy, none of the six women who seroconverted transmitted the infection to their babies. Conclusion: The pooled estimates of HIV seroconversion during pregnancy are high which re-echoes the importance of continuing the implementation of repeat HIV testing especially in areas the prevalence of HIV is considerably high as this would set the stage for detecting seroconversions to enable the timely initiation of ART which is critical reducing the risks of vertical transmission.