Abstract
Background:Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya.Methods:We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing.Results:Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity.Conclusion and Global Health Implications:Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines.
Highlights
Prevention of mother-to-child transmission (PMTCT) of Human Immuno-deficiency Virus (HIV) is among the highest priorities of national HIV programs in sub-Saharan Africa
Between 2015 and 2019, antiretroviral therapy (ART) coverage among pregnant women in Kenya increased from 59% to 94%, while infant infections subsequently declined by 26% from 9,200 in 2015 to 6,800 in 2019.5,6 Early infant diagnosis (EID) coverage at 2 months increased from 53% in 2015 to 69% in 2019;6 falling short of Kenya’s ambitious targets
There is a need to increase early attendance in antenatal care, maternal pre-pregnancy HIV diagnosis, early identification of mothers who seroconvert during pregnancy or breastfeeding, and early infant diagnosis during the first 2 months after birth, in addition, there is a need for interventions like preexposure prophylaxis in breastfeeding women who have an increased risk of acquiring HIV.[27]
Summary
Prevention of mother-to-child transmission (PMTCT) of Human Immuno-deficiency Virus (HIV) is among the highest priorities of national HIV programs in sub-Saharan Africa. While PMTCT services have greatly reduced mother-to-child transmission of HIV (MTCT) since the beginning of the global HIV response, over 90% of the new pediatric infections result from MTCT.[1] In 2019, there were over 150,000 new pediatric infections worldwide, with 110,000 of these within the 21 focus countries (prioritized under the Global Plan) and; >90% are estimated to occur in sub-Saharan Africa.[2] Kenya contributes around 6,600 (6%) of the cases among the Joint United Nations Programme on HIV/AIDS (UNAIDS) Start Free, Stay Free, AIDS-Free twentyone focus countries.[2].
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