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

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Factors associated with low antiretroviral therapy enrollment of children in the Simiyu region: A cross-sectional Creswell mixed-methods sequential explanatory design

“…Mothers delivering at home do not have access to these services, resulting in delays in the early diagnosis of the serostatus of the infant and subsequent non-enrollment in care and treatment services. [ 28 ] Further analyses in our study indicated that home delivery was not significantly correlated with children’s enrollment in treatment and care. These findings suggest that regardless of the place of birth, child ART services are available and accessible despite the place of birth.…”

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.…”

“…However, women who had symptoms of sexually transmitted infections [ 95 ] and more ANC visits [ 64 , 65 , 95 ] were found to be more likely to use the HIV test service. Women who were on ART during pregnancy or at the time of the HIV PCR test and infants who had ARV prophylaxis at birth were positively associated with EID [ 45 , 76 ]. Likewise, factors such as ANC follow-up [ 62 ], birth at a government health facility [ 45 ], and maternal ART adherence [ 89 ] were found to be positively correlated with EID.…”

“…ANC follow-up and facility delivery create an opportunity for early screening and enrolment of mothers and their newborns into the PMTCT service [ 19 ]. Furthermore, studies demonstrated that a child who has used ARV prophylaxis [ 45 , 76 ] or was born from a mother who took ART/HAART [ 76 ] had higher odds of testing for HIV at six weeks. Women on ART and infants on ARV prophylaxis are more likely to access EID services because of good awareness of their HIV status, more frequent medical visits, and increased opportunities for providers to identify HEIs.…”

Maternal retention and early infant HIV diagnosis in a prospective cohort study of HIV-positive women and their children in Malawi

“…However, in our study, independent predictive factors for a lack of EID were not clearly identified. Other studies have investigated on this topic: lack of maternal ART or infant prophylaxis, [17][18][19] lack of maternal ANC attendance, 20,21 new maternal HIV diagnosis, 18 lack of information about the importance of early testing 22 have all been identified as possible predictors of the lack of an EID. In one study in rural Malawi (2013-2016) it was also shown that receiving an infant HIV test result was associated to a reduced infant study retention, especially an infant's positive result.…”