Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test

Abstract

Background Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test at the 18th month. However, most mothers enrolled in the PMTCT-option B+ cascade of services in Tanzania do not turn-up for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for confirmatory HIV testing 18 months post-delivery in Tanzania. Methods This study utilized longitudinal data collected between 2015 and 2017 from 751 mother-baby pairs enrolled in the PMTCT- Option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Analysis was conducted using descriptive statistics to characterize the proportion of mother-baby pairs turning up for a confirmatory test and logistic regression analysis to examine factors associated with turning up for a confirmatory HIV testing at the 18th month. Results A total of 751 mother-baby records were observed only and 44.2% (95% CI: 40.7 – 47.8) of them received the HIV confirmatory test at 18 months. Mothers aged 25 years or above (adults’ mothers) were 1.44 more likely to turn up for confirmatory HIV-testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV-testing compared with partners not tested for HIV; newly HIV-positive mothers diagnosed on enrolment were 28% less likely to turn up their babies for confirmatory HIV-testing compared to known HIV-positive mothers; mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one, and mothers with babies whose DBS-PCR-1 was collected were 3.61 more likely to have confirmatory HIV-testing than those who didn’t collect DBS-PCR-1. Conclusion This study reveals that the turn-up for confirmatory HIV testing at 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This turn-up is associated with low maternal age, having a male partner who has not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the first DBS-PCR HIV test within the first two months post-delivery.