Abstract
In order to eliminate infant HIV infection from mother to child, evidence based implementation strategies are needed to address the risk factors that are associated with this infection using limited resources and applicable to all stakeholders especially the parents of the infants. This study assessed the infant, maternal and paternal risk factors associated with HIV infection among infants below 24 months born to HIV positive mothers in care. An unmatched nested case control study was conducted at the HIV/ART clinic, Mildmay Uganda in 2012. 370 HIV positive mothers with their biological infants below 24 months who had had a DNA-PCR test done in the last 6 months were enrolled in the study (cases: DNA-PCR positive infants, controls: DNA-PCR negative infants). Data was collected using a structured questionnaire. Descriptive, bivariate and multivariate analyses were done. The risk factors that showed a significant relationship with HIV infection of infants below 24 months born to HIV positive mothers were: Infant factors: Infant and young child feeding option used in the first 8 weeks of life (p <0.001) ART status (p<0.001), Immunization status (p=0.031) and duration of receiving Nevirapine syrup of the infant (p=0.002) significantly increased the risk of infection. Maternal factors: High baseline viral load during pregnancy (p=0.046), Body Mass Index > 30kg/m2 (p=0.008), receipt of ART during pregnancy (p<0.001), receipt of nutrition counseling (p=0.002) and non-disclosure of HIV status to spouse of the mother during pregnancy (p<0.001). Paternal factors: Acceptance to test for HIV (p<0.001), non-disclosure of HIV status to spouse (p<0.001) and receipt of ART (p<0.001). Multivariate analysis showed a significant relationship with HIV infection of infants who were mixed fed the infant (OR: 4.971, 95%CI: 1.71 - 14.48, p=0.003), receipt of ART (NVP) of the infant (OR: 0.0062, 95%CI:0.002 - 0.019, p<0.001), mother not disclosing of HIV status to spouse (OR:2.736, 95%CI:1.074 - 6.971, p=0.035) and Father not disclosing of HIV status to spouse (OR:4.38, 95%CI:1.764 - 11.235, p=0.002). The results show that mixed feeding of infants and parental non-disclosure of HIV status are key drivers that significantly increase the risk of infant infection while infant prophylactic Niverapine reduces the risk of infection. It is recommended that exclusively breastfeed of infants born to HIV positive women, HIV testing and spousal disclosure of HIV status be promoted among PLHIV.
Highlights
At the end of 2010, an estimated 34 million people were reported to be living with HIV globally, out of which 3.4 million are children less than 15 years of age. 2.7 million People (1.9million in sub Saharan Africa) were new HIV infections out of which an average of 390,000 were new infections among children less than 15 years [1]
All pregnant women are enrolled for PMTCT, provided with highly active antiretroviral therapy (HAART) and followed up through delivery and their infants followed until 24 months when the last HIV confirmatory test is done, both the mother and child are prospectively followed and vital records taken at particular intervals
Studies have reported significantly high risk of HIV transmission rate among the infants who are mixed fed other studies reported no significant difference in the risk of infection between exclusively breastfeeding and mixed fed infants [16, 17]. Infants who had their first DNA-PCR test done below 8 weeks had a lower risk of infection than those who tested later, this can be linked to the parents of the infant being responsible about their infants health, meaning that they have good medical care-seeking behavior together w ith those whose infants had completed immunization on time, infant HIV infection may be linked to behavior of the parents in seeking medical care and following medical prescriptions and instructions
Summary
At the end of 2010, an estimated 34 million people were reported to be living with HIV globally, out of which 3.4 million are children less than 15 years of age. 2.7 million People (1.9million in sub Saharan Africa) were new HIV infections out of which an average of 390,000 were new infections among children less than 15 years [1]. At the end of 2010, an estimated 34 million people were reported to be living with HIV globally, out of which 3.4 million are children less than 15 years of age. 2.7 million People (1.9million in sub Saharan Africa) were new HIV infections out of which an average of 390,000 were new infections among children less than 15 years [1]. In Uganda, the prevalence of HIV infection in the central region and Kampala is 8.5% (0.7% among children), 10% in urban areas compared to rural prevalence of 6% 57% of people living with HIV are women while 13% are children below 15 years at the time of the study. The Mother to child infection rate was at 4.2% in 2016 [6] This disease burden has increased the morbidity and mortality of these vulnerable children while increasing the cost of care
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