Accessibility of Early Infant Diagnostic Services by Under-5 Years and HIV Exposed Children in Muheza District, North-East Tanzania

Abstract

Introduction: Early infant diagnosis (EID) of Human Immunodeficiency Virus (HIV) provides an opportunity for follow up of HIV exposed children for early detection of infection and timely access to antiretroviral treatment. We assessed predictors for accessing HIV diagnostic services among under-five children exposed to HIV infection in Muheza district, Tanzania.Methods: A cross sectional facility-based study among mother/guardian-child pairs of HIV exposed children was conducted from June 2015 to June 2016. Using a structured questionnaire, we collected information on HIV status, socio-demographic characteristics and other relevant data. Multiple regression analyses were used to investigate associations of potential predictors of accessing EID services.Results: A total of 576 children with their respective mothers/guardians were recruited. Of the 576 mothers/guardians, 549 (95.3%) were the biological mothers with a median age of 34 years (inter-quartile range: 30–38 years). The median age of the 576 children was 15 months (inter- quartile range: 8.5–38.0 months). A total of 251 (43.6%) children were born to mothers with unknown HIV status at conception. Only 329 (57.1%) children accessed EID between 4 and 6 weeks of age. Children born to mothers with unknown HIV status at conception (AOR = 0.6, 95% CI 0.4–0.8) and those with ages 13–59 months (AOR = 0.4, 95% CI 0.2–0.6) were the significant predictors of missed opportunity to access EID. Children living with the head of household with at least a high education level had higher chances of accessing EID (AOR = 1.8, 95% CI 1.1–3.3). Their chances of accessing EID services was three-fold higher among mothers/guardians with good knowledge of HIV infection prevention of mother to child transmission (AOR = 3.2, 95% CI 2.0–5.2) than those with poor knowledge. Mothers/guardians living in rural areas had poorer knowledge of HIV infection prevention of mother to child transmission (AOR = 0.6, 95% CI 0.4–0.9) than those living in urban areas.Conclusion: Accessibility of EID services among children below 5 years exposed to HIV infection in Muheza is low. These findings stress the need for continued HIV education and outreach services, particularly in rural areas in order to improve maternal and child health.

Early infant diagnosis and associated factors among HIV exposed infants in West Shoa Zone, Ethiopia: A mixed methods study

“…In this study, HEIs whose mothers had attended secondary education or above were more than two times more likely to have their HEIs get diagnosed early as compared to whose mother never attended any formal education. This nding is consistent with the ndings of studies conducted in Nairobi Kenya [11] and in Muheza District Tanzania [17]. This may be explained by the fact that educated mothers are more likely to understand, accept and practice the information given during pregnancy and delivery on the importance of early diagnosis of HEIs.…”

“…But, in this study, less than six in ten, 58.5%, of HIV exposed infants were tested and diagnosed early, within six weeks of birth, by using DNA-PCR. This nding is comparable with the ndings of studies conducted in Nairobi, Kenya in 2015 (56.7%) [11], in Muheza District, North-East Tanzania in 2016 (57.1%) [17] and in Zambia in 2012 (58.6%) [18].…”

“…In this study, HEIs whose mothers had known their HIV sero-status before or during pregnancy and had disclosed to any one of the family members were more than six times more likely to be diagnosed early. This nding has also been reported in previous studies conducted in Ethiopia and other countries [10,11,16,17,21,24]. This may be due to the fact that those who had already known their status during or before pregnancy and already disclosed are more likely on PMTCT or ART and may not have any fear of stigma and discrimination.…”

Household socio-economic status and likelihood of HIV infection among under five-year children in Muheza district, north-eastern Tanzania

“…Using a multistage sampling approach, we enrolled a random sample of mother/guardian child pairs. More details of this study have been described elsewhere [28]. More than 79% of households in the district are involved in agriculture as the main source of livelihood and income.…”

Acceptability and feasibility of testing for HIV infection at birth and linkage to care in rural and urban Zambia: a cross-sectional study

“…Clinics within the catchment area collect samples on dried blood spot (DBS) cards that are transported to the laboratory, and results are transported back to the clinic and provided to the mother. Given the number of steps in this process there are many opportunities for delays, such that results are often provided to the mother well beyond the recommended four weeks after sample collection [3] in many areas [4][5][6][7][8]. As a result of these challenges, only 63% of infants in eastern and southern Africa and 21% of infants in western and central Africa [9] are tested as recommended by 8 weeks of age [3].…”