Missed Opportunities for Early Diagnosis of Hiv in Hiv Exposed Infants and Children 0-18 Months at Kiambu Level V Hospital

Abstract

Introduction: Without treatment only half of perinatally infected children celebrate their second birthday. Early detection of HIV infection, and initiation of anti-retroviral therapy (ART) treatment by 7 weeks of life has been has been shown to reduce death and disease progression by 76% and 75% respectively. Objectives: The primary objective was to determine the prevalence of missed opportunities for early diagnosis of HIV in exposed infants and children 0-18 months of age at Kiambu level V Hospital. The secondary objectives were: to identify factors associated with missed opportunities for early HIV diagnosis and repeat testing as per guidelines and proportion of HIV infected children 0-18 months who are linked to comprehensive care. Methodology: It was a retrospective cross-sectional study based on a review of case records of HIV1 infected women and their babies enrolled into the PMCT services between January 2017 and December 2019 and received postnatal care in the facility. The case records of the target population were reviewed to eligibility cases. HIV exposed infants/children were excluded from the study if they had transferred in to the facility at age more than 6 weeks of, transferred out of the clinic within the study period or were on transit. Clinical records were reviewed to determine whether the exposed infant accessed HIV testing as per the current guidelines. Assuming a 31 prevalence of missed opportunity for EID and using Fischers formula the samples size was computed to be of 328 mother- infant pairs. Permission to conduct the study was obtained from the KNH-ERC and the Kiambu County Hospital administration. Results: Mother-infants pairs included in the study were 362. The median age of the babies at enrolment was 6 weeks (IQR 6.6-6.0 weeks). Overall, 51.9% of the children were male and 48.1% were female. The mean age of the mothers was 30.5 years (SD 5.7). The prevalence of missed opportunities for early diagnosis of HIV (at 6 weeks of age) was 14.9% (95% CI 81.5-88.7) and it was noted that 99.2% of the infants had contact with health care worker at 6 weeks of age during immunization. Factors that were associated with missed opportunities for early diagnosis of HIV were: entry point through the inpatient ward; mothers who ART was initiated at same time infant was enrolled and mothers who had no viral load done at time of infant’s enrolment. Infants tested at 6 weeks of age who were found to be HIV infected were 2.9%. Only 77.8% of all HIV infected children 0-18 months of age were started on ART. Only 78.8%

of all the HIV exposed children had all three HIV DNA PCR tests done (at 6 weeks, 6 months and 12 months respectively) and HIV antibody test done at 18 months of age. Conclusion: The prevalence of missed opportunities for early infant diagnosis of HIV was low at 14.9% but could have been lower as 99.2% of infants had contact with a health care worker at 6 weeks of age during immunization. Infants had increased risk of missed opportunity of early diagnosis if they identified at point mother was initiating ART, mother’s lacked a viral load assessment, or identified during admission for inpatient care. At 6 weeks of age 2.9% of the infants were found to be HIV infected but only 77.8% were linked to ART treatment. Only 78.8 of the HIV exposed infants were screened for infection at the 4 recommended time points, HIV DNA PCR tests at 6 weeks, 6 months and 12 months respectively and HIV antibody test at 18 months. Recommendations: 1. To ensure that at infant’s 6 week vaccination, both the mother and infant’s HIV status should be known to avoid delay in early diagnosis of HIV. 2. All patients 0 to 18 months of age admitted in the ward should have a HIV test done as soon as possible to avoid missing any opportunity for early diagnosis and early initiation of treatment. 3. Development of strategies to ensure all HIV exposed infants/children have all four tests done by 18 months of age. 4. Qualitative study with staff at the facility should be considered in future studies to determine the challenges experienced in following guidelines and specifically making sure that no HIV exposed infant/child misses an opportunity for early diagnosis of HIV.