Factors associated with the risk of HIV infection among HIV-exposed infants in Malawi: 2013–2020

Abstract

BackgroundDespite the availability of individual-level data of infants accessing HIV DNA-PCR testing service, there has been little in-depth analysis of such data. Therefore, we describe trends in risk of HIV infection among Malawi’s HIV-exposed infants (HEI) with DNA-PCR HIV test result from 2013 to 2020.MethodsThis is an implementation study using routinely collected patient-level HIV DNA-PCR test result data extracted from the national Laboratory Management Information System database managed by the Department of HIV/AIDS between 1 January 2013 and 30 June 2020. We calculated frequencies, proportions and odds ratio (OR) with their associated 95% CI. We performed a random-effects logistic regression to determine the risk factors associated with HIV infection in infants, controlling for the spatial autocorrelation between districts and adjusting for other variables.ResultsWe evaluated 255 229 HEI across 750 facilities in 28 districts. The HIV DNA-PCR test was performed within 2 months in 57% of the children. The overall HIV prevalence among all tested HEI between 2013 and 2020 was 7.2% (95% CI 7.1% to 7.3%). We observed a decreasing trend in the proportion of HEI that tested HIV positive from 7.0% (95% CI 6.6% to 7.4%) in 2013 to 5.7% (95% CI 5.4% to 5.9%) in 2015 followed by an increase to 9.9% (95% CI 9.6% to 10.2%) in 2017 and thereafter a decreasing trend between 2017 (i.e. 9.72% (95%CI: 9.43-10.01)) and 2020 (i.e. 3.86% (95%CI: 3.34-4.37)). The HIV prevalence increased by age of the HEI. There was spatial heterogeneity of HIV prevalence between districts of Malawi. The prevalence of HIV was higher among the HEI from the Northern region of Malawi.ConclusionThe main findings of the study are that the DNA test is performed within 2 months only in 57% of the children, that the decreasing trend of HIV prevalence among HEI observed up to 2015 was followed by an increase up to 2017 and a decrease afterwards, and that the risk of HIV infection increased with age at HIV testing. We summarised spatial and temporal trends of risk of HIV infection among HEI in Malawi between 2013 and 2020. There is need to ensure that all the HEI are enrolled in HIV care by 8 weeks of age in order to further reduce the risk of HIV in this population.

Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis

“…The studies published between January 2012 and March 2022 were carried out in a range of East African countries; namely, Burundi [ 57 ], Comoros [ 57 ], Ethiopia [ 25 , 45 , 57 – 74 ], Kenya [ 57 , 75 – 78 ], Malawi [ 25 , 45 , 57 – 74 , 79 ], Mozambique [ 57 , 76 – 78 , 80 ], Rwanda [ 57 ], South Sudan [ 81 ], Tanzania [ 82 , 83 ], Uganda [ 39 , 57 , 84 – 87 ], Zambia [ 57 , 88 – 90 ], and Zimbabwe [ 57 , 91 – 96 ]. Studies conducted among eligible pregnant/postpartum women, infants and service providers were included in the analysis.…”

“…The studies published between January 2012 and March 2022 were carried out in a range of East African countries; namely, Burundi [57], Comoros [57], Ethiopia [25,45,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74], Kenya [57,[75][76][77][78], Malawi [25,45,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]79], Mozambique [57,[76][77]…”

“…Studies conducted among eligible pregnant/postpartum women, infants and service providers were included in the analysis. Almost all the studies (44/52) were facility-based [23,25,39,45,[58][59][60][61][62][64][65][66][67][68][69][70][71][72][73][74][76][77][78][79][80][81][82][83][84][85][86][87][88][89][91][92][93][95][96][97][98][99][100][101]. Furthermore, the study design varied across studies: cross-sectional studies (n = 28); prospective cohort (n = 2); retrospective cohort (n = 6), retrospective chart review (n = 4), qualitative studies (n = 8) and mixed methods studies (n = 4).…”

HIV prevalence among children admitted with severe acute malnutrition and associated factors with mother-to-child HIV transmission at Mulago Hospital, Uganda: A mixed methods study

“…While the children over 18 months of age contributed to only 20% of the study population, this study suggests that this age group of severely malnourished children need to be studied further. A large longitudinal study in Malawi among HIV exposed children showed that HIV prevalence increased by age of the HIV exposed child [ 32 ]. A similar study in rural Kenya showed that child age over 6 months at enrolment was associated with HIV infection [ 16 ].…”