Abstract
We identified socio-demographic, health system and psycho-social barriers to Early Infant Diagnosis (EID) of HIV in the Upper West Region of Ghana. An unmatched case control study of 96 cases and 96 controls was conducted in the ART centers in Lawra district and Wa Municipality between December 2014 and April 2015. A public health facility. We defined a case as an HIV positive mother with an exposed infant who received EID service between January 2011 and December 2014. A control was defined as HIV Positive Mother with an exposed infant who did not receive EID services between January 2011 and December 2014. EID by dry blood spot Deoxyribonucleic acid Polymerase chain reaction. A total of 192 mother-infant pairs were assessed. The mean age of infants at testing for cases was 17.3±14.9 weeks. Mother-to-child-transmission-rate was 2.3%. Factors associated with EID testing included: mother being formally employed (cOR=2.0: 95%CI:1.1-3.8), maternal formal education (cOR=2.0, 95%CI: 1.1-3.6) and maternal independent source of income (cOR 2.2, 95%CI 1.2-4.1). After adjusting for confounders, maternal independent income source was associated with EID testing (aOR 2.2, 95%CI 1.2-4.1). Median turn-around time of EID result was 11 weeks (IQR 4-27 weeks). Women need to be empowered to gain an independent source of income. This can help maximize the benefits of e-MTCT and increase EID in the Upper West Region of Ghana. This work was funded by the authors.
Highlights
An estimated 35.3 million people are living with HIV globally with approximately 70% of all infections believed to occur in Africa.[1,2] Transmission of HIV is mainly through sex, among children and infants less than 14 years, 90% of infections are transmitted from mother to the child
Evidence from the Children living with HIV Early antiretroviral therapy (CHER) study of South Africa and others suggest that with effective elimination of mother to child transmission programs (e-MTCT), new infections among exposed infants could be reduced from 40% to less than 5%
We reviewed records to identify all infants who were eligible for Early Infant Diagnosis (EID) between January 2011 and December 2014
Summary
An estimated 35.3 million people are living with HIV globally with approximately 70% of all infections believed to occur in Africa.[1,2] Transmission of HIV is mainly through sex, among children and infants less than 14 years, 90% of infections are transmitted from mother to the child. It is estimated that 14% of all new HIV infections that occur daily are among infants. Evidence from the Children living with HIV Early antiretroviral therapy (CHER) study of South Africa and others suggest that with effective elimination of mother to child transmission programs (e-MTCT), new infections among exposed infants could be reduced from 40% to less than 5%.3-5. Among the factors that have been observed to present challenges in early infant diagnosis of HIV, are lack of effective diagnostic tools and laboratory support, late return of results[9], late or non-reporting of mothers, loss to follow up, lack of husband support or independent maternal income source, as well challenges with disclosure of HIV status.[3,10,11] www.ghanamedj.org Volume 54 Number 2 Supplement June 2020
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