Early vertical HIV transmission and associated factors among HIV exposed infants on early infant diagnosis (E.I.D) program at Lyantonde Hospital

Abstract

Introduction: Vertical HIV transmission continues to be a big challenge and the target of virtually eliminating it by the year 2015 was not achieved. Though considerable progress has been achieved via adoption of Option B plus in many implementing countries, Vertical HIV transmission rates have remained above the set target of less than 5% by 2015. Uganda embraced the Option B plus in October 2012 in bid to eliminate vertical HIV transmission. However, there is a gap in non-utilization of existing records concerning vertical HIV transmission among exposed infants at most of the implementing Health Facilities. This study was set up with the intention of assessing the current early vertical HIV transmission levels and to describe the factors associated with this problem at a rural District Hospital setting through use of the existing records. General objective: To determine the level of early vertical HIV transmission and factors associated with early vertical transmission among HIV exposed infants tested within the first 6 weeks of birth at Lyantonde hospital. Methods: A Cross-sectional study that reviewed records of438 HIV exposed infants who were enrolled into the E.I.D Program within the first 6 weeks after birth having done a Dry Blood Spot (DBS) for HIV- DNA Polymerase Chain Reaction (PCR) within 6 weeks between periods of January 2013 to December 2015. Results: The level of vertical HIV transmission among exposed infants on the EID program was 2.3% (n=10). Utilization of ARVs for PMTCT was 98.4% (n=431) among positive mothers and 93.8% (n=411) among the exposed Infants under the Option B Plus strategy. Deliveries from skilled attendants were 90.7% (n=397) and vaginal deliveries were at 91.6% (n=401). Positive mothers under care in ART clinic were 99.5% (n=436) while the level of maternal HIV status disclosure was 89.9% (n=394). Only five infants (1.1%) presented with signs and symptoms of HIV on 1st visit to the clinic. The presence of signs and symptoms of HIV in exposed infants on their first visit was found to be a strong predictor of possible vertical HIV infection[OR: 64.997(7.330 – 576.311)] and statistically significant (P<0.001). Conclusion and recommendations: Vertical transmission of HIV can effectively be reduced to levels within the target of the Virtual EMTCT campaign by use of the Option B plus.EID Programs are vital as follow up measure in detecting HIV infected babies for timely intervention. Presence of clinical signs and symptoms of HIV/AIDS in an exposed infant at the 6- week visit after birth is a strong clinical predictor of possible vertical HIV infection. Recommendations: HIV exposed infants presenting with signs and symptoms of HIV/AIDS at the 6 week visit should be started on HAART until their first DNA-PCR results are out and show negative results. Health workers in MCH clinics should be more vigilant about eliciting signs and symptoms of HIV in exposed infants and those with missed opportunity as they are a big marker of possible vertical HIV infection. More studies to determine vertical HIV transmission levels among exposed infants between 6weeks and 18 months are needed.