Abstract
Background: To eliminate AIDS by 2030, UNAIDS put forward the objective of reaching 95% diagnosis coverage among people living with HIV, as well as 95% treatment and viral suppression targets. Antenatal care (ANC) remains an important testing modality by which women can be diagnosed and mother-to-child transmission of HIV nearly eliminated. With new testing technologies being implemented and the necessity to optimize HIV testing services, the relative contribution of ANC testing could be changing. This project aims to describe temporal trends in ANC testing and its main determinants in sub-Saharan Africa.
Methods: We included all nationally representative population-based surveys of HIV testing behaviors conducted in SSA over 2005-2020. We extracted data on recent testing, recent ANC testing, and ever testing for women aged 15-49, as well as HIV status, residential area, age, number of births, socioeconomic status (SES), and level of education. We used Bayesian linear mixed model with recent ANC testing as the dependent variable among women reporting a recent HIV test. Clustering was considered using random effects by region, country, and primary sampling unit. Time was modeled using random slopes (linear) and we used poststratification using the survey sampling weights and population denominators to pool estimates.
Results: We included information from 78 surveys, totaling close to 1 million women across 36 countries covering all 4 regions of SSA. Overall, we found that the relative contribution of ANC testing decreased in most regions -despite an increase in overall testing- but that this decline was more pronounced in Western and Central Africa. The contribution of ANC testing was found to be important for women in the lowest SES quintiles and those living in rural areas.
