Mother to child transmission of HIV among infants enrolled for early infant diagnosis before and after the COVID-19 pandemic in Kampala, Uganda: A competing events survival analysis.

Abstract

The COVID-19 pandemic caused disruptions in Uganda’s HIV exposed infant diagnosis (EID) services. Despite the disruptions, there was a paucity of knowledge as to whether they affected the risk of Mother To Child Transmission of HIV. This study sought to apply bounded targeted minimum loss-based estimation (TMLE) in the context of rare outcomes and competing events survival analysis to estimate and compare EID care infant HIV infection cumulative incidence before and after the COVID-19 pandemic, and thereafter identify factors associated with the risk of EID care Infant HIV infection at Kisenyi HC IV in Kampala, Uganda. Health facility EID care data on 557 HIV Exposed Infants (HEIs), 262 before the COVID-19 pandemic and 295 after the onset of the COVID-19 pandemic was collected from paper based registers into Kobo collect and analyzed using R. The Cohort before the COVID-19 pandemic recorded more events (infant HIV infection = 6(2.3%), infant mortality = 16(6.1%)) than the Cohort after the COVID-19 pandemic (infant HIV infection = 2(0.7%), infant mortality = 2(0.7%)). The after COVID-19 pandemic infant HIV infection risk among infants enrolled for EID care at Kisenyi Health Centre IV was lower than the pre COVID-19 pandemic risk. However, the two cohorts were not significantly different in terms of infant HIV infection cumulative incidence (Gray’s Test p-value = 0.15). HIV infection cumulative incidence estimates from the bounded TMLE model were generally higher than those from the unbounded TMLE model. Infant age at the first EID care visit/enrollment (p-value < 0.001), maternal perinatal ART status (p-value = 0.002), and infant breastfeeding status at the last recorded EID care visit (p-value <0.001) were found to be associated with the risk of infant HIV infection.