Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India

Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors...

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Published in:PloS one 2015-07, Vol.10 (7), p.e0131629-e0131629
Main Authors: Thamattoor, Usha, Thomas, Tinku, Banandur, Pradeep, Rajaram, S, Duchesne, Thierry, Abdous, Belkacem, Washington, Reynold, Ramesh, B M, Moses, Stephen, Alary, Michel
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
Agriculture
AIDS
Confidence intervals
Cross-Sectional Studies
Epidemics
Female
Government agencies
Health risk assessment
HIV
HIV Infections - epidemiology
Human immunodeficiency virus
Humans
India - epidemiology
Marriage
Multilevel
Multilevel Analysis
Occupations
Pregnancy
Pregnancy Complications, Infectious - epidemiology
Prevalence
Prostitution
Regression analysis
Sentinel Surveillance
Sex Workers
Sexually transmitted diseases
Statistical analysis
STD
Studies
Surveillance
Workers
Young Adult
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creator Thamattoor, Usha
Thomas, Tinku
Banandur, Pradeep
Rajaram, S
Duchesne, Thierry
Abdous, Belkacem
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Ramesh, B M
Moses, Stephen
Alary, Michel
description Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively. Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity. The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age ≥ 25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age
doi_str_mv 10.1371/journal.pone.0131629
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Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively. Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity. The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age ≥ 25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age&lt;25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04). Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. 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Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively. Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity. The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age ≥ 25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age&lt;25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04). Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26147208</pmid><doi>10.1371/journal.pone.0131629</doi><oa>free_for_read</oa></addata></record>
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1932-6203
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subjects Acquired immune deficiency syndrome
Adult
Agriculture
AIDS
Confidence intervals
Cross-Sectional Studies
Epidemics
Female
Government agencies
Health risk assessment
HIV
HIV Infections - epidemiology
Human immunodeficiency virus
Humans
India - epidemiology
Marriage
Multilevel
Multilevel Analysis
Occupations
Pregnancy
Pregnancy Complications, Infectious - epidemiology
Prevalence
Prostitution
Regression analysis
Sentinel Surveillance
Sex Workers
Sexually transmitted diseases
Statistical analysis
STD
Studies
Surveillance
Workers
Young Adult
title Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India
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