TITLE:
Delay in Early Infant Diagnosis and High Loss to Follow-Up among Infant Born to HIV-Infected Women in Ethiopia
AUTHORS:
Bekana Kebede, Abebaw Gebeyehu, Sonia Jain, Shelly Sun, Richard Haubrich
KEYWORDS:
HIV, Infant, Delay, Loss to Follow-Up, PMTCT, Ethiopia
JOURNAL NAME:
World Journal of AIDS,
Vol.4 No.4,
November
26,
2014
ABSTRACT: Background: Many
HIV-infected infants and children die from HIV related causes without their HIV
status being known or receiving HIV care. All HIV exposed infants should be
tested by Dried Blood Spots (DBS)-PCR before or at 6 weeks of age. Testing is a
crucial step to facilitate early access to antiretroviral treatment (ART).
However, studies that assess the level of use and implementation of HIV DNA testing
in Ethiopia are lacking. Objective: To investigate the rate of early infant
diagnosis (EID), defined as having blood drawn for HIV DNA-PCR testing, and
predictive factors of EID among infants born to HIV infected women. Method: A
multicentre retrospective cohort study was conducted from April to June 2012 in
three public hospitals and three health centers, in Northwest Ethiopia.
Mother-infant pairs were followed from delivery until the time of the HIV
diagnostic test. Data were captured using standardized forms. The
time-to-diagnostic test was estimated using Kaplan-Meier estimators. Factors
associated with EID were evaluated using logistic regression. Result: Of the
266 HIV-exposed infants identified from the health facilities, only 109 (41.0%)
infants had early HIV DNA-PCR tests. The median age at the time of HIV
diagnostic testing was 60 days (95% CI: 47 - 73 days), and the median
turnaround time between blood draw for DNA-PCR testing to delivery of a test
result to the respective health facility was 36 days (95% CI: 33 - 40 days). A
total of 35 (13.2%) infants were diagnosed with HIV infection. The predictors
of EID were the mother having prenatal care, maternal receipt of ART during
pregnancy and place of birth. Conclusion: Three out of five HIV-infected women
did not bring their infant for HIV testing during the recommended 6 week
interval after birth. Special attention is required for infants born to
HIV-infected women who did not receive ART or delivered at home or a private
health facility to ensure early infant diagnosis, reduce loss to follow-up and
prevent late initiation of ART for HIV-infected infants.