Utilization of early infant diagnosis of HIV services and feeding practices among HIV positive mothers in Dar es salaam, Tanzania

Abstract

Background: The human immunodeficiency virus (HIV) infection in children is associated with high morbidity and mortality; studies have demonstrated that about 50% of these children die before their second birthday if not treated early. Following the introduction of early infant diagnosis (EID) using DNA PCR with dried blood spots (DBS) samples, many children who show up to the clinic early have opportunity to be tested according to the national guidelines. Early infant diagnosis of HIV infection not only helps to start antiretroviral therapy for HIV infected children, but it is also an opportunity to assess the infant feeding decisions and breastfeeding problems. Breastfeeding is still a recommended safe infant feeding option in resource limited settings to HIV exposed infants. However effective measures to prevent mother to child transmission (MTCT) of HIV through breast milk such as effective anti retroviral (ARV) prophylaxis or ART for eligible mothers are mandatory. Objectives: To determine the utilisation of early infant diagnosis of HIV services and feeding practices among HIV-exposed infants attending the care and treatment centres (CTC) in Dar es salaam, Tanzania.

Methodology: A cross sectional hospital based descriptive study was conducted among HIV exposed infants attending postnatal clinic and CTC. Data collection included interviewing mother/ guardian using a standard structured questionnaire, review of antenatal (ANC) and reproductive and child health (RCH) cards. Median, range and means were used to summarize continuous data, proportions and rates for categorical data. Data analysis was done using statistical package for social science version 16. Chi square and Fisher’s exact tests were used to determine association between categorical variables, p value of < 0.05 was considered statistically significant.

Results: A total of 432 parents/ guardians- infant pairs were involved in the study, 53.7% were females with mean age of 19 weeks ± 11.8. More than half (68.3%) of the parents/ guardians brought their HIV exposed infants for HIV early infant diagnosis on the given appointment dates. More than half (62.7%) of the infants had results at the end of the study and of these 9 (3.3%) were HIV positive. Median turnaround time (TAT) was 7weeks (1-41wks), reason was no results at the clinic (79%). Few HIV mothers (31.9%) expected to continue breast feeding after HIV results of their infants,43.2% stopped breast feeding at median age at 12 weeks because of fearing of HIV transmission to their infants (p = 0.039).

Conclusion: More than half of the HIV exposed infants were brought for EID of HIV and had their results. Turnaround time (TAT) was 7 weeks with a reason that HIV results were not yet back at clinic; it is longer than the WHO recommended time of 4 weeks. Fear of HIV transmission to the infants was associated with low breast feeding rates.

Recommendations: There is a need for a study to establish the reasons for long TAT as well as strengthen the information, education and counseling on infant feeding practices.