Factors associated with time from birth to the first HIV testing, and drivers of late HIV testing among HIV-exposed infants tested at Kawempe National referral hospital, Kampala city, Uganda

Abstract

ABSTRACT Background: The Early infant HIV diagnosis at 6 weeks is the crucial intervention for the detection of HIV acquired in utero or during birth in HIV-exposed infants, and in enabling timely initiation of ART for those infants who turn positive, therefore improving their overall health. However, three in every five HIV-exposed infants are tested late in Uganda and some are never tested at all. There is a paucity of data about the time from birth to first HIV testing, associated factors and drivers of late testing among HIV-exposed infants tested at Kawempe National Referral Hospital, Kampala City, Uganda. Objectives: To assess the time from birth to the first HIV testing, associated factors and drivers of late HIV testing among HIV-exposed infants. Methods: A parallel convergent mixed methods study was employed in two phases. The first phase was a quantitative, retrospective cohort study reviewing 256 mother-baby pair records. The second phase was a qualitative, cross-sectional study involving 17 in-depth and key informant interviews. The median time from birth to first HIV testing was estimated by Kaplan Meir, and associated factors were identified using Cox proportional hazards using STATA 14. The thematic content analysis was used to identify drivers for late HIV testing among HIV-exposed infants by generating codes, sub-themes, and themes, and presented using quotes. Results: Out of the total 256 HIV-exposed infants who were assessed, only 162 (63.28%) presented for the first HIV testing before or at 45 days as recommended by WHO. The median time from birth to first HIV testing was 44 (IQR 41-) days and was highly associated with the Nevirapine prophylaxis receipt after birth (adjusted Hazard ratio of 5.6 at 95% CI 1.19-26.41). Poor health status of mother and baby, failure to disclose HIV status, financial constraints, long distance to the health facility as well as culture and traditions, were among powerful drivers for late HIV testing Conclusion: The median time from birth to the first HIV testing in this study was shorter than in most studies done in Sub-Saharan and East African countries, and was heavily linked to Nevirapine prophylaxis receipt. The late HIV testing among HIV-exposed infants observed in this study was driven by various maternal, community and health system factors, which need to be addressed by behavioral change communications and health system strengthening.