Missed opportunities for early infant HIV diagnosis : results of a national study in South Africa

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Authors

Woldesenbet, Selamawit A.
Jackson, Debra J.
Goga, Ameena Ebrahim
Crowley, Siobhan
Doherty, Tanya
Mogashoa, Mary M.
Dinh, Thu-Ha
Sherman, Gayle G.

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Lippincott Williams and Wilkins

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.

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Keywords

EID service, Missed opportunities, HIV-exposed infants, Mother-to-child HIV transmission, Early infant diagnosis (EID), Human immunodeficiency virus (HIV), Provider-initiated counseling and testing (PICT)

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Citation

Woldesenbet, SA, Jackson, D, Goga, AE, Crowley, S, Doherty, T, Mogashoa, MM, Dinh, TH & Sherman, GG 2015, 'Missed opportunities for early infant HIV diagnosis : results of a national study in South Africa', Journal of Acquired Immune Deficiency Syndromes, vol. 68, no. 3, pp. e26-e32.