Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study

Dlama Nggida Rasmussen*, Holger Werner Unger, Morten Bjerregaard-Andersen, David Da Silva Té, Noel Vieira, Inés Oliveira, Bo Langhoff Hønge, Sanne Jespersen, Margarida Alfredo Gomes, Peter Aaby, Christian Wejse, Morten Sodemann

*Corresponding author for this work

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Background The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. Objectives To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. Methods We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson’s χ2 test. Results Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73–1.84), as was a lower educational status (APR 1.05; 95% CI 1.00–1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01–1.09) and on Sundays (APR 1.14; 95% CI 1.07–1.22) and Mondays (APR 1.12; 95% CI 1.05–1.19). Conclusions Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.

Original languageEnglish
Article numbere0199819
Issue number8
Number of pages15
Publication statusPublished - 2018



  • Adolescent
  • Adult
  • Counseling
  • Cross-Sectional Studies
  • Female
  • Guinea-Bissau/epidemiology
  • HIV Infections/diagnosis
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical/prevention & control
  • Pregnancy
  • Prenatal Care
  • Prevalence
  • Retrospective Studies
  • Young Adult

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