Review and Follow up Findings on HIV Serodiscordance among Couples in Benue State Nigeria

Abstract

Background: Sexual contact with an HIV infected individual is a significant risk in HIV transmission. We observed occurrence of HIV sero-discordance among some couples in our environment and went further to determine the prevalence of such discordance in Benue state, Nigeria. Aim: To report HIV discordance rate among couples attending some antenatal care clinics in Benue state, Nigeria in order to stimulate search for factors responsible for such discordance. Methodology: This study was carried out in collaboration with the Site Coordinators of Prevention-of-Mother-to-Child-Transmission (PMTCT) programs in Benue State, Nigeria. Antenatal care clients attending HIV/AIDS Counseling &Testing were screened for HIV from January 2006 to December 2008. At screening HIV testing was done using paired commercial HIV rapid tests run in parallel. Fourth generation enzyme immunoassays (EIA) HIV kits Manufactured by Alere Medical Company Limited and Trinity Biotech were used. To confirm partner’s positivity, paired rapid-assay were also used. Manufacturers’ instructions were fully followed. Each of the HIV positive patients was requested to come along with her spouse at the next follow up visit for partner counseling and screening. Socio-demographic data were obtained from all subjects. A group of discordant couples were followed up till December, 2012. Results: A total of 3,508, 5,531, and 4,475 women were counseled and screened annually from 2006 to 2008. HIV positive patients recorded in those years were 15.8%, 17.4% and 46.5% respectively. The peak HIV prevalence occurred in the 21-30 years age group. Among the positive patients, the following percentages accepted partner notification; 53.5% (2006), 72.0% (2007), 67.3% (2008) and came back on consequent follow up visit with their partners while 25%, 15.7%, 47.0% partners accepted to be screened in 2006, 2007 and 2008 respectively. Among the partners screened, there was a sero-discordance of 46% (n=34/74) in 2006. 57% (n=62/109) in 2007 and 45.3% (n= 298/658) in 2008. The highest incidence of HIV sero-discordance occurred among couples < 5 years old in marriage(40%), couples with history of sexually transmitted infections in the past one year(55%) and male circumcision(30% in uncircumcised, 70% in circumcised). Among a cohort of 20 discordant couples consecutively followed up, 80% of the couples were still seen and sero discordant four years after the initial discovery. Conclusion: We recommend risk-reduction behavior, empowerment of vulnerable groups, effective life planning skills as well as behavioral and cultural change among couples. This group of patients can be a major study point for identification of possible factors responsible for prevention of HIV transmission. These findings should guide prevention interventions in order to achieve maximal impact.