Missed opportunities for early diagnosis of HIV in HIV exposed infants and children 0-18 months at a Level V Hospital, Kenya – Cross sectional study

Abstract

Background: In infants, early detection, and initiation of anti-retroviral therapy (ART) by 7-weeks of life has been shown to reduce death  and disease progression by 76% and 75% respectively.

Aim: To determine the prevalence of missed opportunities for early diagnosis of HIV in exposed infants and children 0-18 months of age  at and associated factors.

Methods: A retrospective study of HIV infected women and their babies enrolled into the PMCT services between January 2017 and  December 2019. Patient records were utilized to determine whether HIV status had been ascertained at age of 6-weeks, 6-months, 12- months and 18-months. Descriptive statistical analysis was followed to determine frequencies and percentages. Logistic regression was  carried out to obtain prevalence odds ratios between outcome and independent variables. Means were compared with Student’s t-test and medians with a post-hoc bootstrapped quantile regression.

Results: Seventy-seven percent of all HIV-infected children were started  on ART. At age 6-weeks, 99.2% of all infants in this study had contact with a healthcare worker during the immunization clinic visit. Of  these, 8.0% (95% CI 5.2-10.8) were not tested for HIV. Some factors associated with missed opportunities for early diagnosis of HIV  included entry point through the inpatient ward, and mothers whose ART was initiated at same time infant was enrolled.

Conclusion:  There are several missed opportunities in children despite contact with healthcare workers at 6weeks immunization visits and a large  proportion of children who are started on ART, do not receive HIV DNA PCR testing at appropriate age intervals thereafter.