Utilization of the early infant diagnosis of HIV infection and its associated factors in coast region Tanzania

Abstract

Background: Early infant diagnosis (EID) of HIV infection provides the opportunity for identifying, follow up and testing for HIV-exposed infants. This potentially confers benefit to both HIV-infected, uninfected infants and their families through proper counseling, linkages to comprehensive HIV care, safe infant feeding options and follow up for growth monitoring and development. In Tanzania, despite of availability of EID of HIV infection testing services, many children are left undiagnosed or diagnosed late that resulted to increased childhood HIV related mortalities. Objectives: To determine magnitude and factors influencing utilization of EID among HIV-exposed infants as tracer factors to be shared at different levels of policy making to facilitate planning and proper implementation of EID for HIV. Methodology: A cross-sectional study was conducted in Kibaha and Bagamoyo districts in Coast region involving all HIV-exposed infants aged between 4 weeks to 18 months born live to HIV-infected mothers. Data were collected through interviewing mothers/guardians of HEI using a structured questionnaire, CTC cards were used to countercheck linkage to CTC. A checklist was used to collect data specific for health facilities through interview of health care providers and observation. Data were entered into Epidata version 3.1 analysed by Stata software 12.1. Analysis for predictors was done using univariate and multivariate logistic regression where p value of <0.05 was considered as statistically significant. Results: A total of 238 parents/guardians of HIV-exposed infants/children from five (5) facilities in Coast region were involved in the study. The HIV testing among HIV-exposed infants within the health care facility was 87%. The prevalence of HIV infection among HIV-exposed infants who were tested by HIV-1 DNA PCR method was 13%. All facilities had availability of commodities for EID of HIV, trained human resources, system of identification of HIV-exposed infants. In univariate analysis, early HIV testing during pregnancy, PMTCT ARV prophylaxis, disclosure of HIV status, enrollment to CTC, frequent attendance to EID services, co-trimoxazole prophylaxis and exclusive breast feeding were found to be significant predictors for testing of HIV-exposed infants. Inmultivariate analysis, monthly attendance to HIV EID clinic was independent significant predictor (AOR 2100, 95% CI, 3.3 -1314904 p<0.05) for testing of HIV-exposed infants. Conclusions: High utilization of EID and decreased prevalence of HIV infection coupled with availability of commodities for identifying and testing, skilled health care providers and PMTCT services coverage with availability of more efficacious drugs were found among Tanzanian HIV-exposed infants. Monthly attendance to HIV EID clinic predicted significantly the testing among HIV-exposed infants however cotrimoxazole prophylaxis was not a predictor for HIV testing among exposed infants. Recommendations: The Tanzania government should focus on implementation of global plans for elimination of Mother to child HIV transmission (e-MTCT) through strengthening of the existing system and collaboration with different partners stakeholders to scale up EID services to all levels of health facilities. The Ministry of Health should strengthen the existing health system to ensure uninterrupted supply of PMTCT/EID consumables and proper service delivery. The community should be sensitized on early HIV testing during pregnancy, appropriate PMTCT intervention and early and consistent follow up of mother infant pair for proper HIV intervention..