Determinants of timeliness in the routine monitoring of HIV-Exposed Infants (HEI) at health facilities in Kampala district.

Abstract

Background: Early Infant Diagnosis (EID) testing is a critical strategy for improving early detection and monitoring of HIV among HIV-Exposed infants (HEIs). Uganda implemented EID services across all HIV points of care in 2018. However, challenges in ensuring timely implementation of EID indicators persist. This study assessed determinants of timeliness in the routine monitoring of HIV-Exposed Infants (HEI) at health facilities in Kampala district. Methods: A mixed-methods study design using an explanatory concurrent approach was employed, integrating both quantitative and qualitative data. Quantitative data were collected using a customized data abstraction tool from EID registers (HMIS ACP: 017), while qualitative data were obtained through open-ended questionnaires administered to healthcare workers. Quantitative data were analyzed using descriptive statistics (frequencies and percentages), and associations were assessed using chi-square tests. A modified Poisson regression model was used to identify factors independently associated with the timeliness of EID indicators, with adjusted Prevalence Ratios (aPRs) reported at a 5% level of significance. Qualitative data were analyzed thematically, and closed-ended responses were summarized using a 5-point Likert scale. Results: A total of 300 HIV-exposed infants were included in the quantitative analysis, of whom 159 (53%) were male. The mean age was 8 months (range: 3–17 months; SD = 2). Overall, 198 (66%) HEIs received EID program indicators in a timely manner. Factors independently associated with poor timeliness included a history of poor maternal ART adherence in the preceding six months, long distance from home to the health facility (>20 km), and younger maternal age (≤24 years). Good maternal ART adherence in the past six months was identified as a protective factor. Qualitative findings from 16 healthcare workers revealed key challenges, including gaps in knowledge of EID indicator definitions, shortages of healthcare personnel, inadequate availability of computers, and limited HMIS tools. Conclusion and recommendations. Timely monitoring of EID program indicators remains suboptimal and is influenced by both individual and health system–related factors. Missed or delayed clinic visits undermine the effectiveness of EID services and increase the risk of mother-to-child HIV transmission. Strengthening maternal appointment adherence, improving availability of essential infrastructure such as computers and HMIS tools, and enhancing healthcare worker capacity through regular training and mentorship are recommended to improve the timeliness of EID program indicators.