Outcome evaluation of compliance to early infant diagnosis of HIV testing protocol among HIV exposed children in regional referral hospitals, Dar es salaam, Tanzania

Abstract

ABSTRACT Background: Background: After birth, all HIV-exposed children aged 0-18 months are eligible to receive a series of HIV tests as per the early infant diagnosis (EID) protocol recommendations to rule out their HIV infection status as early as possible. However, early infant diagnosis (EID) of HIV testing remains a challenge owing to guidelines compliance, though evidence is inconclusive. This study therefore, evaluated the compliance to EID of HIV testing protocol among HIV exposed children aged 0-18 months, and its associated factors. The results will inform policies and practices on the implementation status of EID of HIV testing protocol in Tanzania and countries with similar contexts. Methods: A cross section method using quantitative approach was used to gather data from 288 pairs of HIV infected mother and HIV exposed children (observation unit). They were selected using convenient sampling techniques from the regional referral hospitals. Data was collected using standardized questionnaire containing health provider compliance questions, compliance to EID of HIV testing implementation questions, social demographic data of the mother, maternal factors, and health facility factors to the respective participants. The outcome variable of interest was compliance to EID of HIV implementation protocol. Data analysis was conducted using descriptive statistics, bivariate and multivariate logistic regression analysis to address the research objectives. Results: Only 72.6% of mothers living with HIV complied to the EID of HIV testing protocol, although a significant majority (83.3%) of health workers were well-acquainted with the EID of HIV testing protocol and utilize it consistently during daily routine implementation. Mothers on antiretroviral therapy for at least two years were more likely to adhere to EID HIV testing compared to their peers with less duration (AOR=2.28, 95% CI: 1.05-4.95). Moreover, those who resided at least 5km from the health facility were twice more likely to adhere to this recommendation (AOR=1.97, 95% CI: 1.04-3.73). Perceived benefits of EID for HIV (AOR =2.57 (95% CI: 1.26-5.24) and less average time spent to receive EID services (AOR= 3.20, 95% CI: 1.48-6.88) were also associated with compliance to EID services. vi Conclusion and recommendations: Although a significant proportion of health workers are well-acquainted with EID protocols for HIV testing in Dar es salaam, Tanzania; only seven in ten of mothers living with HIV complied to the EID of HIV testing protocol for their exposed children. Improving this crucial HIV elimination intervention can be achieved with tailored interventions targeting immediately diagnosed mothers or those on ART for a shorter period, providing services closer to where they live, improving counseling on EID, and improve efficiency in service provision to cut down waiting time.