Factors associated with HIV positive sero-status among exposed infants attending care at health facilities: a cross sectional study in rural Uganda

Kahungu, Methuselah Muhindo; Kiwanuka, Julius; Kaharuza, Frank; Wanyenze, Rhoda K.

doi:10.1186/s12889-018-5024-6

Cited by 19 publications

(25 citation statements)

References 9 publications

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“…It is also consistent with the finding from a study by Jamieson et al (2012) (43) which showed that infant Nevirapine for 28 weeks was effective in reducing HIV transmission during breastfeeding (43). According to a report by Kahungu et al (2018) and Fisseha and Bereket (2016), infants who did not receive ART prophylaxis at birth had a five-fold risk of being HIV infected compared to those who received prophylaxis (44,45). Similarly in an…”

Section: Duration Of Breastfeeding and Hiv-free Survivalsupporting

confidence: 88%

HIV-free survival among breastfed infants born to HIV-positive women in post-conflict northern Uganda: a perspective from two tertiary health facilities

Nyeko

Aguti

Kimbugwe

et al. 2019

Preprint

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Background Without interventions, the risk of mother-to-child transmission of HIV is up to 25% during pregnancy, labour and delivery with an additional risk of 5-20% during breastfeeding period, leading to an overall rate of up to 45%. Giving anti-retroviral therapy to the mother and anti-retroviral prophylaxis to the infant has been shown to significantly reduce the risk of HIV transmission through breastfeeding to less than 5%. According to the World Health Organization standard, the effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting is measured by its HIV-free survival rate. We therefore carried out a study aimed at determining the HIV-free survival among breastfed infants in a resource poor setting in relation breastfeeding duration. Methods A cross-sectional retrospective study using routine clinical data and involving 365 HIV exposed infants followed up in two tertiary facilities in northern Uganda between 2014 and 2016. Data was analysed using Statistical Package for Social Scientists version 16 software package. Results Of the three hundred and sixty five (365) infants sampled for this study, 86.8% (317/365) were enrolled within the first 2 months of life, 12.1% (44/365) between 3-12 months of age and 1.1% (4/365) enrolled after 12 months of age. Almost all the infants (98.4%) were initiated on Nevirapine prophylaxis, 97.5% (356/365) of whom were initiated within 72 hours. The overall HIV-free survival rate in the current study was 93.7% (342/365), while 6.3% (23/365) were either HIV-infected (2.7%) or died (3.6%). The infants’ age at enrolment was the single most important factor significantly associated with HIV-free survival. The overall duration of breastfeeding did not significantly affect the HIV-free survival: 98.1% (304/310) for children breastfed > 12 months versus 100% (15/15) for those breastfed ≤12 months, though exclusive breastfeeding for at least 6 months was protective. Conclusions Adherence to current approaches to prevention of mother-to-child transmission of HIV with support to breastfeeding in low income countries can greatly enhance HIV-free survival for breastfed infants, and supports the current infant and young child feeding recommendations. Key words: HIV-free survival, Mother-to-child transmission, Breastfeeding, Antiretroviral therapy

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Section: Duration Of Breastfeeding and Hiv-free Survivalsupporting

confidence: 88%

HIV-free survival among breastfed infants born to HIV-positive women in post-conflict northern Uganda: a perspective from two tertiary health facilities

Nyeko

Aguti

Kimbugwe

et al. 2019

Preprint

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“…A total of nine countries and 33 studies were included in this systematic review and meta-analysis. Of this, sixteen studies were from Ethiopia (5-11, 21-24, 26-28, 37, 38 ), five studies were from Kenya [ 12 , 15 , 20 ], three studies were from Tanzania [ 13 , 16 ], three studies were from Uganda [ 14 , 18 , 19 , 31 ], two studies were from Zimbabwe [ 33 , 34 ], and the remaining one study was from Eritrea [ 19 ], South Sudan [ 32 ], Malawi [ 35 ], and Rewanda [ 36 ]. In this review, eighteen studies were cross-sectional study designs while fifteen studies were cohorts (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The place of delivery [ 6 , 7 , 10 , 14 , 18 , 21 , 24 , 25 , 27 , 38 , 39 ], mixed feeding [ 6 , 9 , 15 , 21 , 25 , 27 , 39 ], mother’s age [ 5 , 24 ], residence [ 7 , 27 ], time to initiate infant prophylaxis [ 7 – 10 , 27 ], mother’s HIV stage [ 9 , 18 ], antenatal care visits [ 8 , 9 , 18 ], prevention of vertical HIV infection [ 6 , 7 , 24 ], and feeding practices [ 7 , 8 , 24 ] were a number of the factors for acquisitions of HIV infection for exposed infants and children. Of these factors, four factors (place of delivery, duration of mother on ART, initiation of ART prophylaxis for newborns, and mixed feeding) were chosen to work out their effect on vertical HIV infection.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of vertical HIV infection and its risk factors among HIV exposed infants in East Africa: a systematic review and meta-analysis

2020

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Background Human immunodeficiency virus (HIV) is one of the most important global health problems. More than one and half million of children are living with HIV in the world, and majority of them are found in sub-Saharan Africa. There are primary fragmented study findings, and no review was conducted with regard to vertical HIV infection in East Africa. Therefore, this review aimed to assess the prevalence of vertical HIV infection and its risk factors among HIV-exposed infants in East Africa. Main body Eligible studies were retrieved by relevant search terms in CINHAL, Pub-MED, Google Scholar, EMBASE, Web of Science, SCOPUS, Cochrane, African Journals Online databases, and Ethiopian University research repositories. Data were extracted with Microsoft Excel and analyzed with Stata version 11 software. The random effect model was used to estimate the pooled prevalence of vertical HIV infection in East Africa. The variation between studies was quantified with an I2 statistic test. Furthermore, sub-group and meta-regression analyses were done to identify the sources of heterogeneity between the studies. The publication bias was assessed by Egger test. This systematic review and meta-analysis have included a total of 33 research articles. The overall pooled prevalence of vertical HIV infection in East Africa was 7.68% with a 95% confidence interval [CI]: (6.23, 9.12) with a heterogeneity of I2 = 86.8 with a p value < 0.001. In subgroup analysis, the pooled prevalence of vertical HIV infection in cross-sectional studies was 6.58%, while in cohort studies were 9.37%. Mixed feeding, AOR = 6.22 (1.02, 11.41); home delivery, AOR = 2 (1.01, 3); mothers took ART less than 4 weeks, AOR = 1.92 (1.79, 2.06); and infants who have not received ARV prophylaxis, AOR = 2.02 (1.05, 2.98) were the associated factors for vertical HIV infection for exposed infants. Conclusions The pooled prevalence of the mother to child transmission of HIV is way more than the desired target of the World Health Organization, which is less than 5% in breastfeeding populations. Thus, strengthening the prevention of vertical HIV transmission, promotion of exclusive breastfeeding, timely initiation of ART prophylaxis for HIV exposed infants, encouragement of hospital delivery, and the start of ART at the time of diagnosis of every HIV-positive person may all reduce the transmission of vertical HIV infection.

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“…For example, maternal CD4 count during pregnancy, mixed feeding, and being hospitalized since birth were noted among children born to mothers in PMTCT programs in Zimbabwe [36]. A study among HIV exposed children in Uganda observed that infants who did not receive ART prophylaxis at birth and children delivered outside the health facility were more likely to be HIV-positive than their counterparts [37]. Significant association between malnutrition and HIV status in children has been observed in many countries, including Burkina Faso, Ghana, Rwanda, and India [38][39][40][41][42].…”

Section: Gaps In Testing Coverage and Efficacy For Orphans And Vulnermentioning

confidence: 99%

Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project

Exavery¹,

Charles²,

Kuhlik³

et al. 2020

BMC Health Serv Res

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Background: Tanzania has met only 50.1% of the 90% target for diagnosing HIV in children. The country's pediatric case finding strategy uses global best practices of index testing, provider-initiated counselling and testing, and targeted community testing of at-risk populations to find about 50,000 children living with HIV (CLHIV) who are undiagnosed. However, context-specific strategies are necessary to find the hidden children to meet the full 90% target. This study assesses whether sex of the caregiver is associated with HIV status of orphans and vulnerable children (OVC) as a valuable strategy for enhanced pediatric case findings. Methods: Data originate from the community-based, United States Agency for International Development (USAID)funded Kizazi Kipya Project, which works towards increasing OVC's and their caregivers' uptake of HIV/AIDS and other health and social services in Tanzania. Included in this study are 39,578 OVC ages 0-19 years who the project enrolled during January through March 2017 in 18 regions of Tanzania and who voluntarily reported their HIV status. Data analysis involved multi-level logistic regression, with OVC HIV status as the outcome of interest and caregiver's sex as the main independent variable. Results: Three-quarters (74.3%) of the OVC included in the study had female caregivers, and their overall HIV prevalence was 7.1%. The prevalence was significantly higher (p < 0.001) among OVC with male caregivers (7.8%) than among OVC with female caregivers (6.8%), and indeed, multivariate analysis showed that OVC with male caregivers were significantly 40% more likely to be HIV-positive than those with female caregivers (OR = 1.40, 95% CI 1.08-1.83). This effect was the strongest among 0-4 year-olds (OR = 4.02, 95% CI 1.61-10.03), declined to 1.72 among 5-9 year-olds (OR = 1.72, 95% CI 1.02-2.93), and lost significance for children over age 9 years. Other significant factors included OVC age and nutritional status; caregiver HIV status and marital status; household health insurance status, and family size; and rural versus urban residence.

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Factors associated with HIV positive sero-status among exposed infants attending care at health facilities: a cross sectional study in rural Uganda

Cited by 19 publications

References 9 publications

HIV-free survival among breastfed infants born to HIV-positive women in post-conflict northern Uganda: a perspective from two tertiary health facilities

HIV-free survival among breastfed infants born to HIV-positive women in post-conflict northern Uganda: a perspective from two tertiary health facilities

Prevalence of vertical HIV infection and its risk factors among HIV exposed infants in East Africa: a systematic review and meta-analysis

Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project

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