Determinants of residual HIV infection among exposed infants in Jinja District, Eastern Uganda

Abstract

Background: Mother-to-child HIV transmission has significantly reduced since the scale-up of multiple interventions globally, including in Uganda. However, with the annual new HIV infections at 130,000 and the lowest since the 1980s, the efforts fall short of the target of fewer than 20,000 new infections by 2020. The purpose of this study was to determine the factors associated with residual HIV infection (MTCT of HIV above <5%) among HIV-exposed infants in Jinja district, eastern Uganda. Methods: An unmatched case-control study was conducted on 198 (66 cases and 132 controls) infants paired with their mothers from 1st January 2017 to 30th June 2020. Cases and controls were selected using simple random sampling. Logistic regression was used to identify the factors associated with residual infant HIV infection. It was supplemented with qualitative data from midwives and HIV-positive mothers. Qualitative data was analyzed using thematic analysis. Results: Sixty (90%) of cases compared to thirty-nine (29.5%) of controls were at high risk of HIV infection. Mothers who weren’t on ART before pregnancy compared to mothers who were on ART before pregnancy (AOR=6.9, 95% CI:1.84-28.01), without an HIV viral load test (AOR=4.06, 95% CI:1.09-15.04), with unsuppressed viral load versus those with a suppressed HIV viral load (AOR=5.80, 95% CI:1.53-23.37) and infants that didn’t receive nevirapine compared to those that received nevirapine (AOR=5.64, 95% CI:1.83-17.31) were significantly associated with residual Infant HIV infection. Qualitative findings showed that non-disclosure of HIV status, delayed PMTCT interventions, absence of PMTCT services in private and level-two public health facilities, poor maternal adherence to ART, not attending ANC and the presence of unskilled birth attendants took precedence in contributing to residual infant HIV infections. Conclusion: Late PMTCT interventions, limited access to PMTCT services, non-disclosure of HIV status, and poor maternal adherence to ART remain key challenges to reducing residual infant HIV infections among exposed infants in the era of widespread PMTCT services. Recommendation: There is an urgent need to improve access to PMTCT services in all health facilities that provide maternal and child health services to ensure early identification and initiation of ART for all women infected with HIV and to improve the quality of PMTCT services in health facilities.