Abstract
Background:Improving efforts toward elimination of mother-to-child transmission of HIV requires timely early infant diagnosis (EID) among all HIV-exposed infants, but the occurrence of timely EID and infant survival may be underascertained in routine, facility-bound program data.Methods:From March 2015 to May 2015, we traced a random sample of HIV-positive mother and HIV-exposed infant pairs lost to follow-up for EID in facility registers in Zimbabwe. We incorporated updated information into weighted survival analyses to estimate incidence of EID and death. Reasons for no EID were surveyed from caregivers.Results:Among 2651 HIV-positive women attending antenatal care, 1823 (68.8%) infants had no documented EID by 3 months of age. Among a random sample of 643 (35.3%) HIV-exposed infants lost to follow-up for EID, vital status was ascertained among 371 (57.7%) and updated care status obtained from 256 (39.8%) mothers traced. Among all HIV-infected mother–HIV-exposed infant pairs, weighted estimates found cumulative incidence of infant death by 90 days of 3.9% (95% confidence interval: 3.4% to 4.4%). Cumulative incidence of timely EID with death as a competing risk was 60%. The most frequently cited reasons for failure to uptake EID were “my child died” and “I didn't know I should have my child tested.”Conclusions:Our findings indicate uptake of timely EID among HIV-exposed infants is underestimated in routine health information systems. High, early mortality among HIV-exposed infants underscores the need to more effectively identify HIV-positive mother–HIV exposed infant pairs at high risk of adverse outcomes and loss to follow-up for enhanced interventions.
Highlights
The timeliness of early infant diagnosis (EID) – human immunodeficiency virus (HIV) testing of exposed infants six to eight weeks after birth – and proportion of infants testing positive, are cardinal indicators ofD prevention of mother to child transmission (PMTCT) program success.[1]
Among a random sample of 643 (35.3%) HIV-exposed infants lost to follow-up for EID, vital status was ascertained among 371 (57.7%) and updated
Study Design We defined lost-to-follow up (LTFU) as no documented sample taken for EID polymerase chain reaction (PCR) testing among infants of HIV-positive antenatal care (ANC) patients within 90 days of delivery
Summary
The timeliness of early infant diagnosis (EID) – HIV testing of exposed infants six to eight weeks after birth – and proportion of infants testing positive, are cardinal indicators of. D prevention of mother to child transmission (PMTCT) program success.[1] in routine program settings, completion of EID is assessed at individual facilities, from information across. E several paper-based registers, which may be incomplete and/or inaccurate.[2,3] T New approaches are needed to improve confidence in estimates of EID completion and survival of HIV-exposed infants to guide on-going quality improvement and inform national. These become increasingly important as countries such as Zimbabwe, with an HIV prevalence of 16.0% among women,[4] seek to validate elimination of mother to child E transmission.[5].
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Schedule a callMore From: Journal of acquired immune deficiency syndromes (1999)
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