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Epidemiological features of HIV infection among pregnant women in Botswana Yadav Bindeshwar P Anderson Marina G Mine Madisa Moyo Sikhulile Seipone Khumo

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Background Information on epidemiological characteristics of epidemic is essential to develop strategies, programmes and activities to combat HIV epidemic in a country. To provide evidence based information for intervention 2009 Botswana ante-natal sentinel surveillance aimed to study epidemiological features of transmission of HIV infection among pregnant women

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3 Objectives: To determine prevalence of HIV infection among pregnant women as marital status To determine prevalence of HIV infection among pregnant women as occupation To determine proportion of number of pregnancies as HIV seroprevalence status To determine seroconversion over time among pregnant women prevalence of HIV infection among pregnant women as marital status To monitor trends of HIV infection among pregnant women of 15-49 years old over time, and across sites. To use left over blood for routine tests during ANC visits to determine HIV prevalence, and HIV incidence.

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Methodology Survey Design an anonymous, unlinked, cross-sectional survey. Study population Pregnant women aged 15 to 49 years attending public health facilities Facilities participated In all 24 districts of the country 262 facilities Data collection period 13 July 2009 9 October 2009

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Socio-demographic health status variables used in survey Age of participant (years) Marital status Gravidity (number of pregnancies) Educational level of participant (grade 0- University) Employment status Main occupation Previous HIV status HAART status

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First ANC visit of current pregnancy YES NO (not eligible for survey) Routine prenatal consultation Completion of ANC record Routine blood draw** Completion of survey form Two tubes: 1.Purple top tube (name and barcode) 1.Mix 5 10 times 2.Red top tube (name & code) 1.Let it stand and clot PURPLE TOP Mix Send to District lab to do routine testing for Hb and blood grouping. Vial with Name Do routine syphilis testing at the District Lab Send results to health facility and National Health Lab RED TOP Transport tube on upright in rack in cooler box to the local lab Completed survey all forms accompany specimen to district lab then National Health Laboratory DBS Cards preparation (see SOP): Prepare 3 DBS cards Dry in appropriate racks Pack and send to National Health Laboratory weekly For HIV testing Result sent back to health facility. Specimen Flow First ANC visit of current pregnancy YES NO (not eligible for survey) Routine prenatal consultation Completion of ANC record Routine blood draw** Completion of survey form Two tubes: 1.Purple top tube (name and barcode) 1.Mix 5 10 times 2.Red top tube (name & code) 1.Let it stand and clot PURPLE TOP Mix Send to District lab to do routine testing for Hb and blood grouping. Vial with Name Do routine syphilis testing at the District Lab Send results to health facility and National Health Lab RED TOP Transport tube on upright in rack in cooler box to the local lab Completed survey all forms accompany specimen to district lab then National Health Laboratory DBS Cards preparation (see SOP): Prepare 3 DBS cards Dry in appropriate racks Pack and send to National Health Laboratory weekly For HIV testing Result sent back to health facility.

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Data Analysis Valid forms 7339 were analyzed using Microsoft Excel and Epi Info version 3.5.1 statistical software

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Sociodemographic status of the participants 73% were below 30 years of age, 80% were single mother, 7% co-habiting 37% had 3 or more number of pregnancy 20% domestic helper followed by 13% professionals 58% (1383/2399) among total tested positive were known earlier positive 3713 (out of 7339) were known negative before the current pregnancy

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Married had lowest prevalence and living together highest through out 2000-2009

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HIV prevalence among antenatal women as number of pregnancy No. of pregnancyTotalHIV positiveHIV Prevalence (%) 1248043217.4 2215970632.7 3131658944.8 4 & more138467248.6

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40 years and above are small in umber. Therefore not included here.

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No. of pregnancy Confirmed Known Positive % Confirmed Known PositiveOthers% Others 11218.7235939.6 236726.5179230.1 337827.393815.7 4 & more51737.486714.6 Total1383100.05956100.0

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Earlier tested negative3713 (100%) Present tested negative3167 (85%) Present tested positive546 (15%)

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Earlier all were tested negative

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Earlier not tested1967 Present tested negative1529 (78%) positive438 (22%)

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CONCLUSIONS Co-inhibiting women and single women are at high risk of getting HIV infection in compare to married women. HIV positive women may be considered as high risk group for transmission of HIV infection as they have more number of pregnancy in compare to women who are HIV negative or unknown to HIV status. A large number of HIV positive pregnant female are unaware of their HIV status

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Recommendations In addition, sociological study would provide in put to understand better the high transmission rate among some sub population. To study risk factors for high prevalence rate among co-inhibiting women. Encourage people who practice unsafe sex for voluntary testing

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Thanks