Factors associated with vertical transmission of HIV during the PMTCT B-plus era in Kyegegwa District: A cross-sectional study

Abstract

Background: Despite high antiretroviral therapy coverage (93%) for PMTCT, the vertical transmission rate in Uganda is still high (7.4%). We examined the factors associated with vertical transmission of HIV during implementation of PMTCT option B+ in rural western Uganda. Methodology: We conducted a cross sectional study targeting HIV exposed children in Kyegegwa district. We interviewed mothers to exposed children attending EID clinics at three health facilities between July to September 2018 to ascertain infant and maternal factors associated with vertical transmission of HIV. Data was collected using a semi-structured questionnaire and clinic records were reviewed to obtain infant HIV test results, status of infant nevirapine syrup at birth and maternal viral load results. A chi-square test was used to determine the factors associated with vertical transmission of HIV followed by binary logistic regression at 5% level of significance. Results: Two hundred and eight exposed infants (89%) participated in the study and their median age was 17months [IQR=14-24 months]. Eight percent (8/208) were HIV positive. Attendance of antenatal care (aOR 0.05, 95% CI 0.01-0.30, p-value=0.002), ART during pregnancy (aOR 0.2, 95% CI 0.05-0.87, p-value=0.03), and age at infant 1st DNA PCR HIV test (aOR 0.14, 95% CI 0.03-0.61, p-value=0.008) were associated with lower odds of vertical transmission of HIV while missed infant nevirapine prophylaxis was associated with higher odds of MTCT of HIV (aOR 14, CI 95% 2.9-71.2, p-value=0.001). Conclusion: Missed infant nevirapine prophylaxis was associated with increased odds of MTCT. Recommendation: Minimize missed opportunities of infant nevirapine prophylaxis by provision of nevirapine syrup prior to labour and delivery.