Abstract:
BACKGROUND : Services to diagnose early infant HIV infection
should be offered at the 6-week immunization visit. Despite high
6-week immunization attendance, the coverage of early infant
diagnosis (EID) is low in many sub-Saharan countries. We explored
reasons for such missed opportunities at 6-week immunization visits.
METHODS : We used data from 2 cross-sectional surveys conducted in
2010 in South Africa. A national assessment was undertaken among
randomly selected public facilities (n = 625) to ascertain procedures for
EID. A subsample of these facilities (n = 565) was revisited to assess the
HIV status of 4- to 8-week-old infants receiving 6-week immunization.
We examined potential missed opportunities for EID. We used logistic
regression to assess factors influencing maternal intention to report for
EID at 6-week immunization visits.RESULTS : EID services were available in .95% of facilities and 72%
of immunization service points (ISPs). The majority (68%) of ISPs
provide EID for infants with reported or documented (on infant’s
Road-to-Health Chart/booklet—iRtHC) HIV exposure. Only 9% of
ISPs offered provider-initiated counseling and testing for infants of
undocumented/unknown HIV exposure. Interviews with selfreported
HIV-positive mothers at ISPs revealed that only 55% had
their HIV status documented on their iRtHC and 35% intended to
request EID during 6-week immunization. Maternal nonreporting for
EID was associated with fear of discrimination, poor adherence to
antiretrovirals, and inadequate knowledge about mother-to-child
HIV transmission.
CONCLUSIONS : Missed opportunities for EID were attributed to poor
documentation of HIV status on iRtHC, inadequate maternal knowledge
about mother-to-child HIV transmission, fear of discrimination,
and the lack of provider-initiated counseling and testing service for
undocumented, unknown, or undeclared HIV-exposed infants.
