Woldesenbet, Selamawit A.Jackson, Debra J.Goga, Ameena EbrahimCrowley, SiobhanDoherty, TanyaMogashoa, Mary M.Dinh, Thu-HaSherman, Gayle G.2015-03-192015-03-192015-03Woldesenbet, 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-e32.1525-4135 (print)1944-7884 (online)http://hdl.handle.net/2263/44062BACKGROUND : 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.en© 2014 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.EID serviceMissed opportunitiesHIV-exposed infantsMother-to-child HIV transmissionEarly infant diagnosis (EID)Human immunodeficiency virus (HIV)Provider-initiated counseling and testing (PICT)Article