Predictors of maternal HIV acquisition during pregnancy and lactation in sub-Saharan Africa: A systematic review and narrative synthesis

PLoS One. 2024 Dec 3;19(12):e0314747. doi: 10.1371/journal.pone.0314747. eCollection 2024.

Abstract

Objectives: To eliminate vertical transmission of HIV, global institutions recommend using a risk-guided approach for HIV prevention services in antenatal and postnatal settings. Identifying predictors of maternal HIV acquisition can inform the development of risk-guided approaches, but individual studies of predictors can have limited power and generalizability.

Methods: We conducted a systematic review and narrative synthesis to identify common predictors of maternal HIV acquisition in sub-Saharan Africa (SSA). We searched four databases for full-text articles that estimated associations between at least one predictor and risk of HIV acquisition among pregnant and/or lactating women (PLW) in SSA. We restricted our synthesis to predictors assessed in at least four study populations. For these predictors, we summarized how each predictor was defined and used vote counting and descriptive statistics to characterize overall trends.

Results: We identified 26 eligible publications that summarized results from 24 unique studies. Studies were implemented in 12 countries between 1988 and 2021 and enrolled a total of 164,480 PLW at risk of acquiring HIV. Of the 66 predictors evaluated, 16 met our inclusion criteria. Estimated associations tended to be imprecise and variability in how predictors were measured precluded meta-analyses. We observed trends towards a higher risk of maternal HIV acquisition among young women and women who reported early coital debut, multiple partnerships, sexually transmitted infections, being unaware of partner HIV status, or having a partner living with HIV. In most studies, PLW in stable, monogamous relationships experienced a lower risk of acquiring HIV than those who were single, separated, or in a polygynous marriage. HIV risk perception, condom use, and vaginal drying were also commonly associated with HIV acquisition risk.

Conclusions: In our systematic review and narrative synthesis, we identified several easily measured characteristics that were associated with HIV acquisition among PLW in multiple study populations across SSA. Such findings can support the development and refinement of risk-guided approaches for HIV prevention in the region.

Publication types

  • Systematic Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Female
  • HIV Infections* / epidemiology
  • HIV Infections* / transmission
  • Humans
  • Infectious Disease Transmission, Vertical* / prevention & control
  • Lactation*
  • Pregnancy
  • Pregnancy Complications, Infectious* / epidemiology
  • Risk Factors

Grants and funding

This study was funded by the National Institute of Allergy and Infectious Diseases (NIAID) through award R01 AI131060. Additional investigator, trainee, and administrative support was provided by NIAID (T32 AI007001, K24 AI120796, P30 AI050410, R01 AI157859), and the Fogarty International Center (D43 TW009340, D43 TW010558). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.