Comparison of programmatic data from antenatal clinics with population-based HIV prevalence estimates in the era of universal test and treat in western Kenya

Julie Ambia; Julio E Romero-Prieto; Daniel Kwaro; Kathryn Risher; Sammy Khagayi; Clara Calvert; David Obor; Malebogo Tlhajoane; Fredrick Odongo; Milly Marston; Emma Slaymaker; Brian Rice; Chodziwadziwa Whiteson Kabudula; Jeffrey W Eaton; Georges Reniers

doi:10.1371/journal.pone.0287626

Comparison of programmatic data from antenatal clinics with population-based HIV prevalence estimates in the era of universal test and treat in western Kenya

PLoS One. 2023 Jun 26;18(6):e0287626. doi: 10.1371/journal.pone.0287626. eCollection 2023.

Authors

Julie Ambia¹, Julio E Romero-Prieto¹, Daniel Kwaro², Kathryn Risher^{1

3}, Sammy Khagayi², Clara Calvert^{1

4}, David Obor², Malebogo Tlhajoane¹, Fredrick Odongo², Milly Marston¹, Emma Slaymaker¹, Brian Rice⁵, Chodziwadziwa Whiteson Kabudula⁶, Jeffrey W Eaton³, Georges Reniers^{1

6}

Affiliations

¹ Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
² Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya.
³ MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
⁴ Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
⁵ MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁶ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Objective: To compare HIV prevalence estimates from routine programme data in antenatal care (ANC) clinics in western Kenya with HIV prevalence estimates in a general population sample in the era of universal test and treat (UTT).

Methods: The study was conducted in the area covered by the Siaya Health Demographic Surveillance System (Siaya HDSS) in western Kenya and used data from ANC clinics and the general population. ANC data (n = 1,724) were collected in 2018 from 13 clinics located within the HDSS. The general population was a random sample of women of reproductive age (15-49) who reside in the Siaya HDSS and participated in an HIV sero-prevalence survey in 2018 (n = 2,019). Total and age-specific HIV prevalence estimates were produced from both datasets and demographic decomposition methods were used to quantify the contribution of the differences in age distributions and age-specific HIV prevalence to the total HIV prevalence estimates.

Results: Total HIV prevalence was 18.0% (95% CI 16.3-19.9%) in the ANC population compared with 18.4% (95% CI 16.8-20.2%) in the general population sample. At most ages, HIV prevalence was higher in the ANC population than in the general population. The age distribution of the ANC population was younger than that of the general population, and because HIV prevalence increases with age, this reduced the total HIV prevalence among ANC attendees relative to prevalence standardised to the general population age distribution.

Conclusion: In the era of UTT, total HIV prevalence among ANC attendees and the general population were comparable, but age-specific HIV prevalence was higher in the ANC population in most age groups. The expansion of treatment may have led to changes in both the fertility of women living with HIV and their use of ANC services, and our results lend support to the assertion that the relationship between ANC and general population HIV prevalence estimates are highly dynamic.

Copyright: © 2023 Ambia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
HIV Infections* / diagnosis
HIV Infections* / epidemiology
Humans
Kenya / epidemiology
Pregnancy
Pregnancy Complications, Infectious* / epidemiology
Prenatal Care
Prevalence

Grants and funding

This study was made possible with support from the Bill and Melinda Gates Foundation for the MeSH Consortium (OPP1120138), and the Bill and Melinda Gates Foundation ALPHA grant (OPP1164897). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.