Sentinel Surveillance for HIV-1 Among Pregnant Women in a Developing Country: 3 Years' Experience and Comparison With a Population Serosurvey

AIDS. 1993 Jun;7(6):849-55. doi: 10.1097/00002030-199306000-00014.

Abstract

Objectives: To establish unlinked, anonymous sentinel surveillance for HIV-1 among pregnant women attending an antenatal clinic, to determine age-specific seroprevalences, to monitor trends and to compare seroprevalence with that detected by a population serosurvey. To establish the sustainability and costs of surveillance.

Design: Sentinel surveillance for HIV through serial collection of unlinked, anonymous seroprevalence data from antenatal care; comparison of sentinel data with those from a population serosurvey; financial and general audit of the sentinel surveillance.

Setting: A community antenatal clinic in a large urban centre, Mwanza Municipality, Tanzania, eastern Africa, between October 1988 and September 1991.

Patients: Pregnant women attending for antenatal care.

Main outcome measure: Age-specific HIV-1 seroprevalences, trends over time, difference from age-specific population seroprevalences, sustainability and costs.

Results: Overall HIV-1 seroprevalence was 11.5% (95% confidence interval, 10.5-12.4); differences in age-specific prevalences were not significant. There was no clear evidence of change in seroprevalence over the study period in any age group, although there was some indication of a rise in some age groups in 1988-1989. Sentinel surveillance among pregnant women may have significantly underestimated population HIV-1 seroprevalence for women under the age of 35 years. HIV-1 surveillance proved feasible and sustainable. Additional recurrent costs were US$1.7 per specimen for unlinked anonymous testing and US$0.57 per woman for syphilis screening.

Conclusions: HIV-1 seroprevalence did not change significantly over 3 years, probably implying a substantial incidence of HIV-1 infection. In this setting seroprevalence in pregnant women may have underestimated population seroprevalence in women aged under 35 years. With modest inputs and good organization unlinked anonymous HIV-1 sentinel surveillance of pregnant women can be introduced and sustained in an African setting. This may usefully be carried out in conjunction with syphilis screening.

PIP: Between October 1989 and September 1991, health workers took blood samples from pregnant women attending Makongoro Clinic in Mwanza, Tanzania, to determine age-specific HIV-1 seroprevalence in pregnant women, trends over 3 years, and the feasibility, sustainability, and costs of HIV monitoring and to compare age-specific seroprevalences in pregnant women with those of all women. Overall, HIV prevalence among pregnant women stood at 11.5%. Even though the younger and older age groups had lower seroprevalence than the other age groups (10% for those under 20 years old, 11% for 30-34 year olds, and 8.3% for = or 35 year olds vs. 12.8% for 25-29 year olds and 12.3% for 20-24 year olds), the differences were not significant. HIV seroprevalence appeared to increase in 1988-89 in most age groups, but no significant evidence of a linear trend occurred during the study period for any age group. This absence of significant change in HIV seroprevalence over 3 years likely indicated a considerable HIV incidence. The population serosurvey revealed an HIV seroprevalence of 15.1% among the general adult female population, suggesting that the sentinel surveillance among pregnant women could have greatly underestimated population HIV seroprevalence for women under 35 years old (p = .02). Sentinel surveillance improved the clinic's ability to detect anemia and reintroduced syphilis screening. Unlinked anonymous testing resulted in additional recurrent costs of S$1.7/specimen. Syphilis screening added recurrent costs of US$0.57/woman. These findings indicated that health workers in Africa can successfully introduce and maintain anonymous HIV-1 sentinel surveillance of pregnant women and this can be accomplished with concurrent syphilis screening.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Serodiagnosis* / economics
  • AIDS Serodiagnosis* / methods
  • Adolescent
  • Adult
  • Age Factors
  • Anemia / epidemiology
  • Anemia / prevention & control
  • Comorbidity
  • Developing Countries* / economics
  • Feasibility Studies
  • Female
  • Guidelines as Topic
  • HIV Antibodies / blood
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control
  • HIV Seroprevalence* / trends
  • HIV-1*
  • HIV-2
  • Health Surveys
  • Humans
  • Mass Screening* / economics
  • Mass Screening* / organization & administration
  • National Health Programs / economics
  • National Health Programs / organization & administration
  • Population Surveillance*
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Pregnancy Complications, Infectious / prevention & control
  • Syphilis / epidemiology
  • Syphilis / prevention & control
  • Syphilis Serodiagnosis / economics
  • Tanzania / epidemiology
  • Urban Population
  • World Health Organization

Substances

  • HIV Antibodies