Characteristics of HIV/ Malaria co-infected mothers who did not access early infant diagnosis for their HIV-exposed infants in Benin-City, Nigeria

Abstract

Background: Perinatally-acquired HIV infections rapidly lead to death within one to two years of life. Early infant diagnosis (EID) is the key to early identification with the prompt commencement of treatment. This has been shown to reduce morbidity and mortality. In Nigeria, only 21% of HIV-infected infants are on ARTs. Objective: To determine the characteristics of HIV/Malaria co-infected mothers who did not access EID for their HIV- exposed infants. Methods: HIV infected mothers were recruited from three hospitals during the last trimester of pregnancy and were tested for peripheral and placental malaria at delivery. Socio-demographic and some clinical characteristics were obtained using a proforma. Following delivery, the babies were commenced on the Prevention of Mother to Child Transmission (PMTCT) protocol for HIV including prophylactic Nevirapine therapy, infant feeding counselling and performance of DNA PCR at 6-8 weeks of life. Mothers whose infants did not have DNA PCR results were categorized as having not accessed EID services. Results: Of the 162 infants, only 101 (62.4%) had a DNA PCR test done. The mean age of mothers who did not access EID (31.84±4.8 years) was significantly higher than for mothers who accessed EID (30.58±3.09 years) (p<0.0001). Mothers with low levels of education (p = 0.006), cohabiting mothers (p = 0.0067) and HIV serodiscordant couples (p = 0.0029) were more likely not to access EID. Conclusion: Education, marital status and HIV serodiscordance are significant determinants of accessing EID services. Assessment of these factors at first contact with a pregnant HIV-infected woman allows risk categorisation for default from EID.