Abstract
INTRODUCTION: Repeat HIV testing during pregnancy is significant to detect new maternal HIV infections and mitigate the risk of mother-to-child HIV transmission. Despite guidelines advocating retesting of initially HIV-negative pregnant women, there is limited information on the implementation of these recommendations. The aim of this study is to assess the magnitude of repeat HIV testing uptake in the third trimester and its associated factors. METHODS: We conducted a convergent parallel mixed method study from November 2021 to April 2022 to determine the prevalence and associated factors for a repeat HIV test among women in the third trimester from Ndirande and Lirangwe primary health facilities in Blantyre. Our quantitative approach involved a retrospective review of antenatal records from July 2020 to June 2021. STATA version 14 was used for descriptive analysis. Frequency distributions, fisher’s tests and multivariable logistic regressions were used to examine the association between repeat HIV testing and selected explanatory variables. The qualitative component was exploratory following phenomenological design. Data were collected from 44 pregnant women and 10 health workers who were purposively selected through focus group discussions in-depth and key informant interviews. Transcripts were coded deductively and inductively manually. The thematic analysis of the data was informed by the Consolidated Framework for Implementation Research (CFIR). RESULTS: Analysis of 369 antenatal records, with 302 from Ndirande and 67 from Lirangwe primary health facilities, revealed that only 30 (8.13%) participants received a repeat HIV test in the third trimester from both facilities. Increasing age reduced the likelihood of accessing repeat HIV testing in the third trimester compared to younger women (OR = 0.43; 95% CI: 0.05–3.86). Age, gravidity, and parity did not significantly impact the probability of retesting. Key factors impeding repeat HIV testing included unfamiliarity with the intervention, inadequate resources and clinic operations. In contrast, confirmation of HIV status and improved neonatal outcomes were motivators for repeat HIV testing. CONCLUSION: Information and counselling on the benefits of repeat HIV testing later in pregnancy is key in increasing uptake and implementation of the service in future pregnancies. In addition, strengthening the clinic operations and improving availability of resources is vital in the implementation and uptake of repeat HIV testing among pregnant women. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-26176-5.