TY - JOUR T1 - Implementation of HIV Retesting During Pregnancy and Postpartum in Kenya: A Cross-Sectional Study JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00451 VL - 10 IS - 1 SP - e2100451 AU - Monalisa Penumetsa AU - Jillian Neary AU - Shiza Farid AU - Peninah Kithao AU - Barbra A. Richardson AU - Daniel Matemo AU - Grace John-Stewart AU - John Kinuthia AU - Alison L. Drake Y1 - 2022/02/28 UR - http://www.ghspjournal.org/content/10/1/e2100451.abstract N2 - Key FindingsDespite guidelines to conduct maternal HIV retesting during pregnancy, labor/delivery, and postpartum, we found HIV retesting was inconsistently conducted in Kenyan prevention of mother-to-child HIV transmission programs.Programmatic retesting was more frequently implemented at 6 weeks and 9 months postpartum than in the pregnancy or delivery.HIV incidence was 3-fold higher during pregnancy than postpartum, suggesting fewer infections acquired postpartum in our study.Key ImplicationsPublic health practitioners need to consider strategies to prevent missed opportunities to detect and treat incident HIV infections during and after pregnancy.Programs focused on the prevention of mother-to-child HIV transmission should measure maternal retesting and document reasons why retesting does not occur to identify service delivery gaps and improve the implementation of programmatic retesting.As mother-to-child HIV transmission rates decline over time with effective interventions, it will be increasingly important to monitor the contributions of maternal HIV incidence to new infant infections to achieve elimination of mother-to-child HIV transmission.Introduction:HIV retesting during pregnancy/postpartum can identify incident maternal HIV infection and prevent mother-to-child HIV transmission (MTCT). Guidelines recommend retesting HIV-negative peripartum women, but data on implementation are limited. We conducted a cross-sectional study in Kenya to measure the prevalence of maternal HIV retesting in programs and HIV incidence.Methods:Programmatic HIV retesting data was abstracted from maternal and child health booklets among women enrolled in a cross-sectional and/or seeking services during pregnancy, delivery, or 9 months postpartum in Kenya between January 2017 and July 2019. Retesting was defined as any HIV test conducted by MTCT programs after the initial antenatal care test or conducted as part of retesting policies at/after delivery for women not tested during pregnancy. Poisson generalized linear regression was used to identify correlates of programmatic retesting among women enrolled at 9 months postpartum.Results:Among 5,894 women included in the analysis, 3,124 only had data abstracted and 2,770 were enrolled in a cross-sectional study. Overall prevalence of programmatic HIV retesting was higher at 6 weeks (65%) and 9 months postpartum (72%) than in pregnancy (32%), at delivery (23%) and 6 months postpartum (28%) (P<.001 for all comparisons). HIV incidence was 0.72/100 person-years (PY) (95% confidence interval (CI)=0.43,1.22) in pregnancy and 0.23/100 PY (95% CI=0.09, 0.62) postpartum (incidence rate ratio: 3.09; 95% CI=0.97, 12.90; P=.02).Conclusion:Maternal retest coverage was high at 6 weeks and 9 months postpartum but low during pregnancy. Strategies to ensure high retesting coverage and detect women with incident maternal HIV infection are needed. ER -