Factors associated with the timely uptake of initial HIV virologic test among HIV-exposed infants attending clinics within a faith-based HIV program in Kenya; a cross-sectional study

Early infant diagnosis (EID) of HIV, followed by effective care including antiretroviral therapy (ART), reduces infant mortality by 76% and HIV progression by 75%. In 2015, 50% of 1.2 million HIV-exposed infants (HEI) in 21 priority countries received a virologic test within the recommended 2 months...

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Published in:	BMC public health Vol. 21; no. 1; p. 569
Main Authors:	Gaitho, Douglas, Kinoti, Freda, Mwaniki, Lawrence, Kemunto, Diana, Ogoti, Victor, Njigua, Catherine, Kubo, Elizabeth, Langat, Agnes, Mecha, Jared
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 23-03-2021 BioMed Central BMC
Subjects:	Age Antiretroviral agents Antiretroviral therapy Babies Birth weight Breast feeding Breastfeeding & lactation Childbirth & labor Children & youth Childrens health Clinics Confidence intervals Cross-sectional studies Demographic aspects Diagnosis Disease prevention Disease transmission Diseases Drug therapy Early infant diagnosis Electronic health records Electronic medical records Health care facilities Health facilities HIV HIV infection HIV testing HIV-exposed infant Human immunodeficiency virus Immunization Infant mortality Infants Infants (Newborn) Infections Laboratories Maternal & child health Medical diagnosis Model testing Mothers Patient outcomes Polymerase chain reaction Pregnancy Prophylaxis Public health Regression models Risk factors Sexually transmitted diseases Statistical analysis STD Vagina Variables Womens health Kenya HIV-exposed infant Early infant diagnosis
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Summary:	Early infant diagnosis (EID) of HIV, followed by effective care including antiretroviral therapy (ART), reduces infant mortality by 76% and HIV progression by 75%. In 2015, 50% of 1.2 million HIV-exposed infants (HEI) in 21 priority countries received a virologic test within the recommended 2 months of birth. We sought to identify factors associated with timely uptake of virologic EID among HEI and gain insight into missed opportunities. This was a cross-sectional study that used de-identified data from electronic medical records of 54 health facilities within the Christian Health Association of Kenya (CHAK) HIV Project database. All HEI who had their first HIV virologic test done between January 2015 and December 2017 were included in the study and categorized as either having the test within or after 8 weeks of birth. Multivariate linear mixed effects regression model was used to determine factors associated with uptake of the first HIV EID polymerase chain reaction (PCR). Predictor variables studied include sex, birth weight, the entry point into care, provision of ART prophylaxis for the infant, maternal ART at time of EID, mode of delivery, and place of delivery. We included 2020 HEI of whom 1018 (50.4%) were female. A majority, 1596 (79.0%) had their first HIV PCR within 2 months of birth at a median age of 6.4 weeks (interquartile range 6-7.4). Overall, HIV positivity rate at initial test among this cohort was 1.2%. Delayed HIV PCR testing for EID was more likely to yield a positive result [adjusted odds ratio (aOR) = 1.29 (95% confidence interval (CI) 1.09-1.52) p = 0.003]. Infants of mothers not on ART at the time of HIV PCR test and infants who had not received prophylaxis to prevent vertical HIV transmission had significant increased odds of a delayed initial test [aOR = 1.27 (95% CI = 1.18-1.37) p = < 0.0001] and [aOR = 1.43 (95% CI 1.27-1.61) p = < 0.001] respectively. An initial HIV PCR test done after 8 weeks of birth is likely to yield a positive result. Barriers to accessing ART for treatment among HIV-infected pregnant and breastfeeding women, and prophylaxis for the HEI were associated with delayed EID. In order to ensure timely EID, programs need to incorporate both facility and community strategy interventions to ensure all pregnant women seek antenatal care and deliver within health facilities.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2458 1471-2458
DOI:	10.1186/s12889-021-10587-1