Clinical Epidemiology and Global Health 8 (2020) 1127–1133

Contents lists available at ScienceDirect

Clinical Epidemiology and Global Health

journal homepage: www.elsevier.com/locate/cegh

Confined vulnerability of HIV infection among pregnant women attending T

antenatal care clinics in Karnataka, India: Analysis of data from the HIV
sentinel surveillance 2017
Aridoss Santhakumara, Balasubramanian Ganesha, Mathiyazhakan Malathia,
Jaganathasamy Nagaraja, Natesan Manikandana, V.M. Padmapriyaa, B.K. Kirubakarana,
Chinnasamy Govindasamya, V. Ramachandrana, Rajendran Sridhara, Pradeep Kumarb,
Shobini Rajanb, Arumugam Elangovana,∗∗
a
ICMR-National Institute of Epidemiology, R-127, 2nd Main Road, TNHB, Ayapakkam, Chennai, 600 077, Tamil Nadu, India
b
National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, 36 Janpath Road, New Delhi, 110 001, India

ARTICLE INFO ABSTRACT

Keywords: Background: HIV Sentinel Surveillance among pregnant women attending antenatal care clinics, ANC-HSS, is
HIV Sentinel surveillance used to estimate HIV prevalence among the general population. Despite the declining trend, HIV prevalence
ANC among the general population in Karnataka is still higher than the national average (0.22%), with a recent,
HIV Prevalence noticeable stabilization. Demographic analysis on concentrated HIV infection among pregnant women could be
Karnataka
potential indicators for targeted HIV interventions among general population as well as and prevention of parent
India
to child transmission (PPTCT).
Objectives: To analyse the demographics of HIV-positive pregnant mothers in Karnataka, thereby identifying the
most-at-risk populations (MARP) within the general population.
Methods: In total, 24800 eligible pregnant women aged 15–49 attending the ANC clinic for the first time during
the surveillance period (Jan–Mar, 2017) were enrolled. Demographic data and blood samples were collected,
recorded and tested for HIV. Age-specific factors associated with HIV prevalence, besides the demographics of
the HIV positive pregnant women, were analysed to identify the MARP for targeted HIV interventions.
Results: Comprehensively, none of the demographic factors was significantly associated with HIV prevalence.
Nevertheless, analysis of demographics, HIV test history and ART status of HIV-positive pregnant women reveals
prominent prevalence patterns. The epidemic was majorly confined within young, less educated, primigravida
and rural mothers of low economic status.
Conclusion: ANC-HSS is designed to estimate the HIV prevalence among general population at national, state and
district levels and is not reflective of the concentrated epidemic confined to MARP. Identifying the disease
pattern specific to MARP is essential for effective targeted interventions and disease management.

1. Introduction
HIV prevalence in India is periodically estimated through various
national surveillance programs. HIV sentinel surveillance (HSS) in-
itiated by the National AIDS control organization (NACO) in 1998 es-
timates the HIV prevalence among the general population as well as the
HIV high-risk groups (FSW, MSM, IDU, TGs) biennially.1 Clients or
partners of HRGs transmit the disease to the general population majorly
through unprotected sex, and rarely via blood transfusions.2 More
specifically, male partners/clients of HRGs in sexual contact with their
female partners (wife/girlfriend) are the main drivers of disease
transmission to the general population, thus acting as the bridge po-
pulation.3 Hence, unprotected heterosexual act is identified as the main
mode of HIV transmission to the general population and HIV prevalence

∗
Corresponding author. Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, R-127, 2nd Main Road, TNHB,
Ayapakkam, Chennai, 600 077, Tamil Nadu, India.
E-mail addresses: elangovan@nie.gov.in, santhakumar.aridoss@gmail.com, niedrbganesh@gmail.com, mithmals@gmail.com, nagarajicmr@gmail.com,
maninatesan87@gmail.com, padmanie2019@gmail.com, kirubakaran@nie.gov.in, govindhasamy@nie.gov.in, ramachandran@nie.gov.in,
sridharmswmp@gmail.com, posurv.naco@gmail.com, shobini.simu.naco@gmail.com, elangovan@nie.gov.ins (A. Elangovan).

https://doi.org/10.1016/j.cegh.2020.04.003
Received 4 December 2019; Received in revised form 20 March 2020; Accepted 3 April 2020
Available online 08 April 2020
2213-3984/ © 2020 INDIACLEN. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.
A. Santhakumar, et al.
Fig. 1. Schematic representation of district-level HIV prevalence among pregnant women attending the antenatal care clinics in Karnataka, 2017.
among pregnant women (ANC-HSS) is, therefore, considered as a proxy
indicator of HIV prevalence among the general population.4
In Karnataka, the estimated adult HIV prevalence of 0.81% in 2006
has declined to 0.47% in 2017. Accordingly, the estimated HIV pre-
valence among ANC clinic attendees in Karnataka was 1.12% in 2006
and has declined to 0.38 in 2017.5,6 Yet, the state-level HIV prevalence
in 2017 among FSWs (3.33%) and MSMs (5.4%) is on the higher end7
and subsequently, HIV adult prevalence of Karnataka (0.47% in 2017)
is still above the national average (0.22% in 2017).6 In spite of the
declining trend in the ANC prevalence, stabilization or slow-down in
the decline has been reached in the recent past7 and the levels of HIV
prevalence vary within districts. In case of Karnataka, the northern
districts have consistently recorded higher HIV prevalence among the
ANC attendees.8 Hence, an in-depth analysis of HSS data of the ANC
attendees, might indicate potential association between any of the de-
mographic variables with the infection risks.
The data from HSS among pregnant women has been considered as
a key indicator of HIV prevalence among the general population.7 Apart
from estimation of HIV prevalence and deriving strategies for HIV in-
tervention, analysis of ANC HSS data might provide valuable insights
on the socio-demographics of the HIV positive pregnant women, which
in turn might lead to indicators such as target groups for HIV inter-
ventions among the general populations, as well as measures to ensure
complete prevention of mother to child transmission (PMTCT). Doc-
umentation of the socio-demographics of the HIV-positive cases has
been done for better understanding of the disease profile in order to
facilitate improved HIV prevention and management measures.9,10 This
paper, thus focuses on understanding the socio-demographics of the
pregnant women with higher infection risks and expands into analysing
the utilization of ANC and HIV testing services by the pregnant mothers
in order to achieve complete PMTCT.
1128
Clinical Epidemiology and Global Health 8 (2020) 1127–1133
1.1. Surveillance methodology
Study Population: All pregnant women aged between 15 and 49 years
who were attending the designated ANC sentinel sites in Karnataka for
the first time during the surveillance period were included in the sur-
veillance.
Study Setting: Data and samples were collected for 3 months between
January, 2017 and March, 2017, or until the desired sample size was
achieved, whichever was earlier. At least two sentinel sites per district;
preferably one from urban and the other from rural were chosen.
Sample Size: The sample size was fixed at 400 for each site.11 In
total, 24775 respondents were included from 62 sites in Karnataka.
Study Design: HSS is a cross-sectional survey that follows consecutive
sampling method, linked anonymous testing strategy and the standard
two-test protocol. In the consecutive sampling method, all eligible
pregnant women, were recruited in the same order in which they attend
the ANC, so as to reduce the selection bias. In order to maintain the
data-quality, data collection was limited to the first 20 eligible re-
spondents in a sentinel site on a given day.
Variables: Information on socio-demographics as well as their HIV
test/ART status, along with blood samples were collected from all eli-
gible respondents Information collected from the respondents were i)
Age, ii) Literacy status, iii) Gravida, iv) Duration of Pregnancy, v)
Source of Referral vi) Current Residence vii) Duration of Stay at the
Current Residence viii) Current Occupation of the Respondent ix)
Current Occupation of the Respondent's Spouse x) Migration Status of
the Spouse. Information related to respondents' HIV testing/ART status
were also included, as follows; i) HIV Test History, ii) Time of the Last
HIV Test, iii) Result of the Last HIV Test, iv) Management of HIV
Infections v) ART Uptake Status. The variables were designed to analyse
the basic socio-demographics and the level of HIV management among
the pregnant women. It is believed that the trend observed among the
pregnant women reflects the disease trends among the general
A. Santhakumar, et al. Clinical Epidemiology and Global Health 8 (2020) 1127–1133

population. The collected blood samples were tested for HIV bio- Table 1
markers. The surveillance methodology is guide-lined andstandardized, Category-wise Distribution and HIV Prevalence of pregnant women attending
wherein the data/sample collection and subsequent testing were done ANC services in Karnataka.
by trained personnel as described elsewhere.7,11 Demographic Variables (Category-wise) Number % HIV Prevalence
Statistical Analysis: Descriptive statistics were used to describe the %
characteristics of the study samples. Chi-square and Fisher's exact tests (N = 24775)
were used to find the association between the age-specific variables and
Age (in years)
HIV prevalence. The logistic regression method was used to find the 15–24 15364 62.0 0.33
association between the demographic variables and the risk of HIV 25–49 9436 38.0 0.47
infection. All data were analysed using SPSS 26.0.12 Literacy Status
Illiterate 2591 10.5 0.46
Literate Up to Standard 5 2139 8.6 0.37
2. Results Literate Standard 6 - 10 13137 53 0.33
Literate Standard 11 to Graduation 6267 25.3 0.43
HIV prevalence among pregnant mothers is considered as proxy for Literate Post- Graduation 634 2.6 0.47
estimation of HIV burden among general population aged between 15 Order of Current Pregnancy
First 10575 42.7 0.43
and 49 years. With reference to general population, P ≥ 1% indicates
Second 9951 40.2 0.32
high prevalence, P = 0.5–0.99 indicates moderate prevalence and Third 3325 13.4 0.36
P < 0.5 indicates low prevalence.13 According to HSS 2017, HIV pre- Fourth or more 924 3.7 0.43
valence in Karnataka was 0.38 marking it as a low prevalence state Duration of Current Pregnancy
First trimester 6193 25 0.4
(Fig. 1).
Second trimester 8466 34.2 0.41
Socio-demographic profile of pregnant women attending ANC Third trimester 10108 40.8 0.34
clinics in Karnataka: Received ANC Service During Current Pregnancy?
Analysis of the factors influencing the HIV prevalence, gave insights Yes 17922 72.4 0.36
on the perception and awareness levels of HIV among the pregnant No 6822 27.6 0.44
Source of Referral to the ANC Clinic
women in Karnataka. The logistic regression found that none of the
Self-Referral 3772 15.2 0.34
demographic factors was significantly associated with HIV prevalence, Family/Friends 5168 20.9 0.52
but certain trends were noted. The HIV prevalence was higher among NGO 46 0.2 4.35
ANC mothers aged between 25 and 49 years (0.47%) than those of Private Healthcare Providers 323 1.3 0.93
Government Healthcare Providers 15427 62.2 0.29
15–24 years (0.33%). HIV prevalence among women with tertiary
ICTC/ART Centres 47 0.2 6.38
education (0.47%) was comparable with those with no education Current Place of Residence
(0.46%). HIV prevalence was higher in primi-gravids (0.43%) than Urban 9922 40.1 0.36
multi-gravids (0.33%). Single (unmarried/widow/divorced) mothers Rural 14818 59.9 0.38
(16%) were the most vulnerable to HIV infections than married women Current Occupation of the Respondent
Truck Driver/Helper 2 0 0
(0.36%). Based on the occupation of the respondents, significantly
Local Transport Worker 3 0 0
higher prevalence (0.31) of HIV infections was among labourers Large Business/Self Employed 6 0 0
(agricultural/non-agricultural/skilled/semi-skilled) representing the Hotel Staff 9 0 0
low-income categories. Significantly higher prevalence (0.69%) of HIV Domestic Servant 54 0.2 0.11
Petty Business/Small Shop 75 0.3 0
infections was seen among the ANC mothers who indicated their spouse
Agricultural Cultivator/ 182 0.7 0
occupation as trucker/local transport worker/hotel staff or who were Skilled/Semiskilled Worker 454 1.8 0.42
migrants (bridge population). The consolidated results categorized Student 475 1.9 0
under the socio-demographical variables are presented in Table 1. Agricultural Labourer 572 2.3 0.48
Socio-demographic profile of HIV positive pregnant women at- Non-Agricultural Labourer 909 3.7 0.7
Government/Private Service 1881 7.6 0.22
tending ANC clinics in Karnataka:
Housewife 20166 81.4 0.38
To probe further, the demographics of the HIV positive pregnant Current Occupation of the Respondent's Spouse
women alone were analysed in order to identify the vulnerable cohort Student 8 0 0
and to understand their disease transmission patterns. However, an in- Not Applicable 25 0.1 16
depth analysis of the demographics of the HIV-positive pregnant Unemployed 27 0.1 0
Domestic Servant 159 0.6 0
women reveals more confined disease patterns, strikingly different from Large Business/Self Employed 377 1.5 0.65
that of the overall ANC-HIV pattern. Of the 24775 respondents, 94 were Agricultural Cultivator 440 1.8 0.24
reported to be HIV positive in the current surveillance. In contrary to Hotel Staff 619 2.5 0.8
the overall HIV prevalence trends observed, this analysis revealed the Truck Driver/Helper 1678 6.8 0.91
Petty Business/Small Shop Owners 2049 8.3 0.49
confinement of the HIV infection among the young mothers (53.20%),
Local Transport Worker 2090 8.4 0.62
with education up to secondary level or lesser (68.1%) and primi- Agricultural Labourer 2642 10.7 0.31
gravids (48.90%). The infected women were majorly from the rural Government or Private Service 2944 11.9 0.19
regions (61.3%) and were housewives (81.9%). The occupation of the Non-Agricultural Labourer 4775 19.3 0.39
spouses of the infected respondents majorly corresponded to low-in- Skilled/Semiskilled Worker 6922 28 0.17
Migration Status of Spouse
come categories such as labourers/workers/small shop owners (60.6%) Yes 277 1.1 1.08
and transport workers (18.1%) (Table 2). No 24488 98.8 0.36
Age-specific analysis of the profile of pregnant women attending Not Applicable 25 0.1 16
ANC clinics in Karnataka: Has Ever Been Tested for HIV
Yes 15432 62.2
We categorized the respondents into 2 age-groups; 15–24 years and
No 9362 37.8
25–49 years. Since, age is also an eligible criterion; data-sheets with If tested HIV, when was the Last Test
improper age records were considered invalid. Among 15-24-years' Tested during current pregnancy 11237 45.3
group, the highest proportion (N = 54.4%) of respondents were pri- Tested before current pregnancy 4185 16.9
migravids whereas in 25–49 years’ group the highest proportion were NA (For never tested) 9362 37.8

secundigravids. As gravida represents the duration of HIV exposure (continued on next page)

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A. Santhakumar, et al. Clinical Epidemiology and Global Health 8 (2020) 1127–1133

Table 1 (continued)
Demographic Variables (Category-wise) Number % HIV Prevalence
%
(N = 24775)
Result of respondent's Last HIV Test
Positive 55 0.2
Negative 15140 61.2
Did not collect the last result 22 0.1
No response 160 0.7
NA (For never tested) 9362 37.8
ART Uptake Status of Known-Positives
Yes 50 0.2
No 4 0
NA (Never tested or Negative when last 24738 99.8
tested)
HIV Test Results from Blood Samples
Negative 24706 99.6
risks, HIV prevalence among primi-gravida is also a proxy indicator for
new infections. A significantly higher prevalence was observed among
primi-gravid women aged between 25 and 49 years (0.9%, P = 0.001),
attending the ANC centre during the first trimester (0.7%, P = 0.004)
when compared to their respective counter-parts (Table 3).
2.1. Variation of HIV prevalence across the districts
At the state-level, ANC HIV prevalence was 0.38% with inter-district
variations. It was higher than that of the state average in 9 districts and
lesser than the state average in 21 districts which includes zero pre-
valence at 3 districts. Thirteen out of 30 districts in Karnataka recorded
HIV prevalence higher than that of the national average of 0.28%7 in
which almost all of the North-Karnataka districts were included.
3. Discussion
3.1. State-level HIV prevalence
The HIV prevalence among pregnant mothers in Karnataka was
0.38% indicating a slight increase since 2015 (0.36%). Based on the
analysis of the socio-demographic factors of the ANC attendees, none of
the factors were significantly associated with the risk of HIV infection
(Table 1). Age-specific analysis showed that HIV prevalence was sig-
nificantly higher among pregnant women aged between 25 and 49
years, as compared to that of 15–24 years (Table 3). Lower HIV pre-
valence among young mothers is in line with the nation-wide declining
trend of the adult HIV prevalence.14 This may be attributed to increased
awareness on HIV and considerable decrease in high-risk behavior
among younger generation, particularly men, thereby reducing the risk
of HIV transmission.15 Education or economic status or place of re-
sidence did not have any significant effect on the overall HIV pre-
valence at the state-level.
However, focusing on the socio-demographics of the HIV positive-
only respondents, higher proportion of the infected mothers were of
young age, with literacy up to or below secondary level, of rural re-
sidence, being housewives, and with partners belonging to the bridge
population/low-income occupational category (Table 2). With respect
to the occupation (of both the respondents and their spouses), we could
see the confinement of the epidemic within the agricultural and non-
agricultural labourers. Concurrently, based on the report on the State
epidemiological factsheets,16 it is to be noted that about 45.9% of the
female sex workers in Karnataka were agricultural or non-agricultural
labourers, indicating a potential trend of disease transmission. Like-
wise, inter-district variations indicate concentration of high HIV pre-
valence in the northern districts of Karnataka. This could be attributed
to the widely prevalent commercial sex practise and the seasonal out-
migration of the labourers to the neighbouring districts and states.17–19
In addition, while a major proportion of the infected mothers were
house wives, the spouses of considerable proportion of the infected
mothers were bridge populations (transport worker/hotel staffs). The
declining trends in the HIV prevalence among pregnant women at-
tending antenatal care clinics thus mask the confined vulnerability of
HIV infection in Karnataka. The data emphasizes the need to channelize
the HIV management programs towards poorly educated adults from
rural areas and low economic background, with special focus on the
house-wives, agricultural and non-agricultural labourers, transport
workers and seasonal migrants.
Availing ANC Services, History of HIV Testing and ART Uptake
Status:
The Prevention of Parent to Child Transmission of HIV/AIDS
(PPTCT) programme commenced in 2002 has mandated HIV testing to
every pregnant woman (universal coverage) in India, so as to cover all
estimated HIV positive pregnant women and eliminate transmission of
HIV from mother-to-child.20 For this, all pregnant mothers must report
to any of the ANC centres within the first trimester of the pregnancy to
ensure risk-free pregnancy and management for high-risk infections
such as HIV/TB.21
At the state-level, about 27.6% of the pregnant mothers had not
availed the ANC services previously and about 37.8% had not been
tested for HIV. Possible reason could be first-order pregnancy/first
trimester of the current pregnancy (Table 1). However, amongst the
HIV infected respondents, 20.1% of them had not received any ANC
services within the first trimester. About 58.5% of the positive cases
were aware of their HIV positive status before their current ANC visit.
About 23.4% of the HIV-positive mothers had never been tested for HIV
earlier of which, 36.4% were multigravida women, thus posing a ser-
ious threat of horizontal and vertical HIV transmission. Among the
known positives, 90.9% were on ART treatment. While 10% of the
known-positives had not considered the ART treatment, indicating a
concerning lack of awareness about HIV management among the
pregnant mothers. Potential reasons for not taking or discontinuation of
ART could be migration, accessibility of the ART owing to increased
travel cost,22 stigmatized attitude and fear of rejection by the spouse.23
About 48% of the total HIV positive cases were primigravida, and a
higher proportion of them (58.7%) were in 15–24 years’ group. About
45.4% of the primigravids were aware of their HIV status of which 72%
had tested for HIV during their current (first) pregnancy indicating new
infections, whereas 28% had acquired the infection before their first
pregnancy. Another trend to be noted is HIV sero-conversion among
pregnant mothers. 12.8% of the HIV positive mothers had been re-
ported HIV negative in their last HIV test taken during the current
pregnancy of which 83.3% were in the second or third trimester. This
suggests the possibility of these mothers to be seroconverted during
later pregnancy and emphasizes the need for HIV retesting during late
pregnancy.
Towards achieving the 95-95-95 goal by 2030 and PPTCT, we
suggest reaching out to the young mothers specifically from less edu-
cated and low-income backgrounds in Karnataka and disseminate HIV-
related information by all possible means. Mandating RCH registration
in PHCs for obtaining birth certificates as done in Tamilnadu,24 would
probably increase the proportion of those accessing the ANC services,
which in turn would reflect on HIV testing and eventually ART uptake.
Concurrently, although testing for HIV has been done by default in all
ANC centres, question arises if the mother and her family members are
aware of the information related to HIV testing and its follow-up. Hence
it is important that all pregnant women undergoing the HIV test are
well-informed about the test and its implications, through pre-test
counselling for productive responses.25 Appropriate pre-/post-test
counselling and integrated state-level ART follow-ups, psychological
support to the infected pregnant women and her family members are
important for continued adherence to ART.

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Table 2
Category-wise Distribution of HIV Positive pregnant women, based on the result of their last HIV test, attending ANC services in Karnataka.
Variable Group Result of Last HIV Test (N = 94) Total %

#
Positive Negative NA 94
Age (in years) 15–24 49.10% 64.70% 54.50% 50 53.20%
25–49 50.90% 35.30% 45.50% 44 46.80%
Education Illiterate 14.50% 5.90% 13.60% 12 12.80%
Up to Std 5 10.90% 0.00% 9.10% 8 8.50%
Std 6 – Std 10 41.80% 58.80% 50.00% 44 46.80%
Std 11 to Undergraduate 30.90% 23.50% 27.30% 27 28.70%
Post Graduate 1.80% 11.80% 0.00% 3 3.20%
Gravida First 45.50% 41.20% 63.60% 46 48.90%
Second 36.40% 41.20% 22.70% 32 34.00%
Third 14.50% 11.80% 9.10% 12 12.80%
Fourth/More 3.60% 5.90% 4.50% 4 4.30%
Trimester First 23.60% 23.50% 36.40% 25 26.60%
Second 29.10% 47.10% 50.00% 35 37.20%
Third 47.30% 29.40% 13.60% 34 36.20%
Availed ANC Services Yes 76.40% 82.40% 36.40% 64 68.10%
No 23.60% 17.60% 63.60% 30 31.90%
Source of Referral Self-Referral 14.50% 6.30% 18.20% 13 14.00%
Family/Relatives/Neighbours/Friends 27.30% 25.00% 36.40% 27 29.00%
NGO 3.60% 0.00% 0.00% 2 2.20%
Private (Doctor/Nurses) 1.80% 12.50% 0.00% 3 3.20%
Govt. (including, ASHA/ANM) 49.10% 56.30% 40.90% 45 48.40%
ICTC/ART Centre 3.60% 0.00% 4.50% 3 3.20%
Residence Urban 33.30% 47.10% 45.50% 36 38.70%
Rural 66.70% 52.90% 54.50% 57 61.30%
Resident Occupation Agricultural Labourer 7.30% 5.90% 18.20% 9 9.60%
Non-Agricultural Labourer 5.50% 0.00% 4.50% 4 4.30%
Domestic Servant 1.80% 0.00% 0.00% 1 1.10%
Skilled/Semiskilled Worker 1.80% 5.90% 0.00% 2 2.10%
Petty Business/Small Shop 0.00% 0.00% 0.00% 0 0.00%
Large Business/Self Employed 0.00% 0.00% 0.00% 0 0.00%
Service (Govt./Pvt.) 0.00% 0.00% 4.50% 1 1.10%
Student 0.00% 0.00% 0.00% 0 0.00%
Hotel Staff 0.00% 0.00% 0.00% 0 0.00%
Truck Driver/Helper 0.00% 0.00% 0.00% 0 0.00%
Local Transport Worker 0.00% 0.00% 0.00% 0 0.00%
Agricultural Cultivator/Landholder 0.00% 0.00% 0.00% 0 0.00%
Housewife 83.60% 88.20% 72.70% 77 81.90%
Spouse Occupation Agricultural Labourer 12.70% 17.60% 22.70% 15 16.00%
Non-Agricultural Labourer 34.50% 11.80% 27.30% 27 28.70%
Domestic Servant 0.00% 0.00% 0.00% 0 0.00%
Skilled/Semiskilled Worker 3.60% 11.80% 4.50% 5 5.30%
Petty Business/Small Shop 10.90% 23.50% 0.00% 10 10.60%
Large Business/Self Employed 1.80% 11.80% 4.50% 4 4.30%
Service (Govt./Pvt.) 7.30% 0.00% 4.50% 5 5.30%
Student 0.00% 0.00% 0.00% 0 0.00%
Hotel Staff 0.00% 11.80% 4.50% 3 3.20%
Truck Driver/Helper 1.80% 5.90% 9.10% 4 4.30%
Local Transport Worker 20.00% 5.90% 4.50% 13 13.80%
Agricultural Cultivator/Landholder 3.60% 0.00% 9.10% 4 4.30%
Unemployed 0.00% 0.00% 0.00% 0 0.00%
Not Applicable 3.60% 0.00% 9.10% 4 4.30%
Spouse Migration Status No 94.50% 94.10% 86.40% 87 92.60%
Yes 1.80% 5.90% 4.50% 3 3.20%
NA* 3.60% 0.00% 9.10% 4 4.30%
Ever been tested for HIV Yes 100.00% 100.00% 0.00% 72 76.60%
No 0.00% 0.00% 100.00% 22 23.40%
Time of Last HIV Test Tested during current pregnancy 49.10% 70.60% 0.00% 39 41.50%
Tested before current pregnancy 50.90% 29.40% 0.00% 33 35.10%
NA 0.00% 0.00% 100.00% 22 23.40%
Result of Last HIV Test Positive 100.00% 0.00% 0.00% 55 58.50%
Negative 0.00% 100.00% 0.00% 17 18.10%
NA 0.00% 0.00% 100.00% 22 23.40%
ART Status Yes 92.60% 0.00% 0.00% 50 53.80%
No 7.40% 0.00% 0.00% 4 4.30%
NA (who were either never tested or not positive when last tested for HIV) 0.00% 100.00% 100.00% 39 41.90%
NA# Denotes the status/result of last HIV test – Never been tested or respondents who did not disclose/collect the result of the last HIV test,
NA* Denotes respondents who were never married or with dissolved marriage (Separated/Divorced/Widowed)
-Missing responses are included.

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A. Santhakumar, et al. Clinical Epidemiology and Global Health 8 (2020) 1127–1133

Table 3 AIDS Prevention Society, Referral Laboratories, State Surveillance

Factors affecting age-specific HIV Prevalence of pregnant women, attending Team members and sentinel sites personnel for their support in com-
ANC services, in Karnataka. pleting the surveillance activities in a timely manner. The authors also
Factors HIV Prevalence (%) P Value express their special gratitude to Dr. Sanjay Madhav Mehendale, former
Additional Director General, Indian Council of Medical Research, New
Age 15-24 Yrs. 25-49 Yrs. Delhi; Prof. DCS Reddy, Former Professor and Head, Department of
Karnataka 0.3 0.5 0.080
PSM, Banaras Hindu University, Varanasi; Dr. Arvind Pandey, Former
Gravida
First 0.3 0.9 < 0.001*** Director, ICMR-National Institute of Medical Statistics, New Delhi; Prof.
Second 0.3 0.3 0.901 Shashi Kant, Professor and Head, Department of Community Medicine,
Third 0.4 0.3 0.585 AIIMS, New Delhi for their immense contribution and technical inputs
Forth or More 0.0 0.5 0.368
towards establishing a robust HIV Sentinel Surveillance system in India.
Duration of Pregnancy
First 0.2 0.7 0.004**
The authors also acknowledge the Institutional Human Ethics
Second 0.4 0.4 0.527 Committee and Scientific Advisory Committee of ICMR-National
Third 0.3 0.4 0.271 Institute of Epidemiology for granting approval of the study.
History of HIV Testing
Previously Tested 0.4 0.5 0.322
References
Never Tested 0.2 0.3 0.190
Availed ANC Services during current pregnancy
Yes 0.3 0.4 0.605 1. Sgaier SK, Claeson M, Gilks C, et al. Knowing your HIV/AIDS epidemic and tailoring
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