Understanding Socioeconomic Disparities in PMTCT Services
Despite efforts to eliminate mother-to-child transmission of HIV (MTCT) across East Africa, socioeconomic inequalities in the utilization of prenatal HIV testing services remain a significant challenge. Prenatal HIV testing is a critical gateway to accessing prevention, treatment, and supportive services for HIV-positive pregnant women, yet access to these services is uneven.
Using a decomposition analysis approach, this study aimed to measure the extent of socioeconomic inequalities in prenatal HIV test uptake and identify the key determinants contributing to these disparities in 10 East African countries.
Measuring Socioeconomic Inequalities in Prenatal HIV Testing
The researchers analyzed data from the most recent Demographic and Health Surveys (DHS) in Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Zambia, and Zimbabwe. Their sample included 45,476 women aged 15-49 who had given birth in the two years preceding the surveys.
The team calculated concentration indices (CI) to quantify the degree of socioeconomic inequality in prenatal HIV test uptake. A positive CI value indicates that the service is more concentrated among higher socioeconomic groups, while a negative value suggests a pro-poor distribution.
The overall CI for prenatal HIV test uptake in East Africa was 0.1594, meaning the service was 15.94% more concentrated among wealthier women. The magnitude of inequality varied significantly across countries, from a high of 40.33% in Ethiopia to a low of 1.87% in Rwanda.
Decomposing Drivers of Inequality
To understand the key factors contributing to these socioeconomic inequalities, the researchers used a regression-based Erreygers decomposition approach. This allowed them to quantify the relative contributions of different socioeconomic and demographic determinants.
The analysis revealed that the largest contributors to inequalities in prenatal HIV test uptake were:
Household Wealth Index (38.99%): Wealthier women were significantly more likely to utilize prenatal HIV testing services compared to their poorer counterparts.
Maternal Education (13.69%): Women with secondary or higher levels of education had higher rates of prenatal HIV testing, contributing to pro-rich inequalities.
Place of Residence (11.78%): Utilization was higher among urban residents, who tended to be of higher socioeconomic status.
Other important factors included partner’s education (8.24%), access to media such as television (7.32%) and radio (7.11%), and reading newspapers/magazines (2.90%).
Addressing Inequities in PMTCT Services
The findings of this study highlight the need for targeted interventions to improve equity in access to prenatal HIV testing services across East Africa. Key policy recommendations include:
Poverty Reduction: Implementing strategies to reduce household wealth disparities, such as social protection programs, can help ensure equitable access to PMTCT services.
Educational Attainment: Improving educational opportunities, especially for women and their partners, can empower individuals to make informed choices about their health.
Expanding Media Access: Leveraging mass media channels like radio, TV, and print to raise awareness and promote uptake of prenatal HIV testing, particularly among disadvantaged groups.
Strengthening Health Systems: Investing in high-quality, integrated PMTCT services in both urban and rural areas can help overcome geographical barriers to access.
By addressing the root socioeconomic determinants driving inequalities, policymakers and practitioners can work towards ensuring equitable access to critical HIV prevention services for all pregnant women in East Africa.
Link to Joint Action for Water website
Socioeconomic Inequalities in Prenatal HIV Testing Across East Africa
Despite significant progress in the global fight against HIV/AIDS, the HIV epidemic continues to disproportionately affect certain regions and populations. Sub-Saharan Africa remains the most severely impacted, accounting for over two-thirds of people living with HIV worldwide. Women and children are particularly vulnerable, with high rates of vertical transmission from mother to child.
Preventing mother-to-child transmission (PMTCT) of HIV is a critical strategy for controlling the epidemic in East Africa. A key component of PMTCT is early identification of HIV-positive pregnant women through provider-initiated testing and counseling during antenatal care. However, research has shown that the utilization of these prenatal HIV testing services is uneven, favoring women of higher socioeconomic status.
To better understand and address these inequities, a team of researchers conducted a decomposition analysis of socioeconomic inequalities in prenatal HIV test uptake across 10 East African countries: Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Zambia, and Zimbabwe.
Measuring the Extent of Inequalities
The researchers used concentration indices (CI) to quantify the degree of socioeconomic inequality in prenatal HIV test utilization. A positive CI indicates that the service is more concentrated among higher socioeconomic groups, while a negative value suggests a pro-poor distribution.
The overall CI for prenatal HIV test uptake in East Africa was 0.1594, meaning the service was 15.94% more concentrated among wealthier women. However, the magnitude of inequality varied significantly across countries:
- Ethiopia had the highest CI at 0.4033, indicating a 40.33% pro-rich inequality.
- Rwanda had the lowest CI at 0.0187, with a 1.87% pro-rich inequality.
These findings demonstrate that while progress has been made in expanding access to PMTCT services, substantial socioeconomic disparities persist across the region.
Decomposing the Drivers of Inequality
To identify the key determinants contributing to these inequalities, the researchers employed a regression-based Erreygers decomposition approach. This allowed them to quantify the relative contributions of various socioeconomic and demographic factors.
The analysis revealed that the largest contributors to inequalities in prenatal HIV test uptake were:
-
Household Wealth Index (38.99%): Wealthier women were significantly more likely to utilize prenatal HIV testing services compared to their poorer counterparts.
-
Maternal Education (13.69%): Women with secondary or higher levels of education had higher rates of prenatal HIV testing, further widening the gap.
-
Place of Residence (11.78%): Utilization was higher among urban residents, who tended to be of higher socioeconomic status.
Other important factors included partner’s education, access to media (television, radio, and newspapers/magazines), and employment status.
Addressing Inequities in PMTCT Services
The findings of this study highlight the need for targeted, multi-pronged approaches to improve equity in access to prenatal HIV testing services across East Africa. Key policy recommendations include:
1. Poverty Reduction: Implementing strategies to reduce household wealth disparities, such as social protection programs, can help ensure equitable access to PMTCT services.
2. Improving Educational Attainment: Expanding educational opportunities, especially for women and their partners, can empower individuals to make informed choices about their health.
3. Leveraging Media Access: Using mass media channels like radio, TV, and print to raise awareness and promote uptake of prenatal HIV testing, particularly among disadvantaged groups.
4. Strengthening Health Systems: Investing in high-quality, integrated PMTCT services in both urban and rural areas can help overcome geographical barriers to access.
By addressing the root socioeconomic determinants driving inequalities, policymakers and practitioners can work towards ensuring all pregnant women in East Africa have equitable access to critical HIV prevention services.
Link to Joint Action for Water website
Conclusion: Achieving Equitable PMTCT Services
The persistence of socioeconomic inequalities in prenatal HIV test uptake across East Africa is a significant barrier to eliminating mother-to-child transmission of HIV. This decomposition analysis underscores the need for targeted, multifaceted interventions to address the complex, interrelated drivers of these disparities.
Tackling household poverty, improving educational opportunities, expanding media access, and strengthening integrated PMTCT service delivery are all crucial elements of a comprehensive strategy to achieve equitable coverage and utilization of these life-saving services. By prioritizing the unique needs of disadvantaged populations, policymakers and practitioners can work towards ensuring no pregnant woman is left behind in the fight against HIV/AIDS.
