Uptake and factors associated with timely completion of early infant diagnosis for HIV exposed infants at Lira Regional Referral Hospital

Abstract

Introduction: HIV exposed infants (HEIs) are at a higher risk of infant mortality compared to their counterparts who are not HIV exposed, with more than 100,000 deaths from AIDS-related causes in 2020. Early Infant Diagnosis (EID) coverage still remains a challenge with only 28% of these HEIs receiving their final rapid test at 18 months of age. According to consolidated Prevention of Mother to Child Transmission (PMTCT) guideline 2020, HEIs are supposed to be tested at: 4-6 weeks, 9 months, 6 weeks after cessation of breastfeeding and 18 months of age for first, second, third DNA-PCR and final rapid HIV test respectively. Aim: To determine the uptake and factors associated with timely completion of EID for HIV exposed infants at Lira Regional Referral Hospital (LRRH). Methods: The study was a retrospective cohort of 252 HIV-exposed infants born in the period of 1st January 2021 to 31st December 2021 chosen through consecutive sampling. Abstraction tool was used to collect data from mother-baby pair files and EID register to check the uptake of 1st, 2nd, 3rd DNA-PCR and final rapid test. The main outcome was EID completion and classified as timely completion and untimely completion according to the PMTCT guideline. Data was analyzed using generalized estimating equation (GEE) with poisson family, log link and unstructured correlation structure to assess factors associated with timely completion of EID testing. Results: The majority of the infants were male and most of their mothers were married with a mean age of 32 years. The uptake of EID among HIV exposed infants at 4-6 weeks, 9 months, 6 weeks after cessation of breastfeeding and 18 months were 80.1% (95% CI:74.5-84.7), 84.2% (95% CI:79.0-88.3), 3.7% (95% CI:2.0-7.0) and 78.8% (95% CI:73.2-83.6) respectively. Having cotrimoxazole given was associated with timely completion of EID (P=0.034). However, factors like infant at risk, mother’s age, time of HIV diagnosis, distance from the health facility, ART prophylaxis and feeding status were not related to timely completion of EID. Conclusion: Uptake of EID was highest at 9 months (84.2%) and lowest at 6 weeks after cessation of breastfeeding (3.7%). Uptake was below Ministry of Health (MoH) targets of 95% at all-time points. Having cotrimoxazole given to infants and an increase in time was associated with timely completion of EID. Therefore, there is need to develop new strategies to support healthcare workers to improve uptake of EID among HEIs to meet MOH target and eventually eradicate HIV in Uganda.