Missed Opportunities for Early Infant HIV Diagnosis: Results of A National Study in South Africa

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Woldesenbet, Selamawit A. ; Jackson, Debra ; Goga, Ameena E. ; Crowley, Siobhan ; Doherty, Tanya ; Mogashoa, Mary M. ; Dinh, Thu-Ha ; Sherman, Gayle G.
• Description:
  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 self-reported 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.
  
  
• Subjects:
  Adolescent Adult Cross-Sectional Studies Early Diagnosis Female Health Services Research HIV Infections Humans Implementation And Operational Research: Epidemiology And Prevention Infant Male Young Adult

  More +
• Source:
  J Acquir Immune Defic Syndr. 2014; 68(3):e26-e32
• Pubmed ID:
  25469521
• Pubmed Central ID:
  PMC4337585
• Document Type:
  Journal Article
• Funding:
  U2G PS001137/PS/NCHHSTP CDC HHS/United States ; 1U2GPS001137-02/PHS HHS/United States ; 1U2GPS001137-03/PHS HHS/United States
• Place as Subject:
  South Africa
• Location:
  Africa
• Volume:
  68
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8a6406b385bd0a77d9b4434e70bf3ceb509459ca0510f131e6167cd5e2f77e84
• Download URL:
  https://stacks.cdc.gov/view/cdc/28490/cdc_28490_DS1.pdf
• File Type:
  [PDF - 594.16 KB ]