High proportion of unknown HIV exposure status among children aged less than 2 years: An analytical study using the 2015 National AIDS Indicator Survey in Mozambique

Abstract

Background Determination of the human immunodeficiency virus (HIV) exposure status in infants and young children is required to guarantee timely diagnosis and access to appropriate care. HIV prevalence among Mozambican women aged 15-49 years is 15%, and vertical transmission rate is still high. The study investigated HIV exposure in children aged less than 2 years in Mozambique and the factors associated with unknown HIV exposure and with HIV exposure status in this population. Methods This was a cross-sectional analytical study using data from the 2015 Survey of Indicators on Immunization, Malaria and HIV/AIDS in Mozambique. A total of 2141 mothers (15-49 years) with children aged less than 2 years were interviewed. The dependent variables were "known HIV exposure status in a child" and "HIV-exposed child," and the explanatory variables were mother's social, demographic, economic, and reproductive health characteristics. We used binary and logistic regression, adjusted for complex sampling, to determine the association between variables. Results HIV exposure status was unknown in 27% of children (95% CI, 25.1-28.9). Mothers residing in the North (AOR, 4.41; 95% CI, 2.18-8.91), in rural area (AOR, 2.44; 95% CI, 1.33-4.35), with no education (AOR, 2.72; 95% CI, 1.38-5.36), and not having utilized any health services in the last pregnancy (AOR, 1.9; 95% CI, 1.42-2.55) were more likely to have a child with unknown HIV exposure status. Six percent of children were HIV-exposed (95% CI, 5-7). Children were less likely to be HIV-exposed if the head of the household was a male (AOR, 0.26; 95% CI, 0.08-0.86), if the mother was residing in the North (AOR, 0.41; 95%

Correlates of loss to follow-up and missed diagnosis among HIV-exposed infants throughout the breastfeeding period in southern Mozambique

“…However, these factors might have affected the early access to PNC and retention throughout the cascade, as reported by other studies conducted in Mozambique, South Africa, and Malawi [ 36 , 39 – 41 ]. Therefore, collecting such data in future studies is crucial to understand whether early linkage and completeness of follow-up are influenced by the same determinants that affect access and retention along all of the steps of the PMTCT cascade [ 20 , 40 , 42 ].…”

“…Despite the provision of integrated care at MCH clinics to mother–infant pairs, the rolling out of lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+, in 2013), and the achievement of 95% ART coverage [ 17 , 18 ], prevailing challenges still prevent all women and their HEI from receiving prompt and appropriate care. The seroconversion of women during the postpartum and breastfeeding period is estimated to be 4.9 per 100 women-years [ 19 ]; moreover, 27% of children who are younger than 2 years have an unknown HIV status [ 20 ], and only 66% of expected HEI accessed EID within 2 months of life [ 18 ].…”

Acceptability and feasibility of a peer-support, ‘Mentor Mother’ program in Gaza, Mozambique

“…Mozambique is a high-priority country for HIV-related programming. Approximately 93,000 children are living with HIV [4], the national HIV prevalence is 13.2% among adults aged 15-49 [5] and the country's highest prevalence is Gaza Province at 24.4% [4].At the time the national mentor mother strategy was launched in 2018, the government of Mozambique reported that retention rates in HIV care and treatment among pregnant women were 65% in Gaza Province versus 81% nationally [6]. Strengthening retention among HIV-positive pregnant and lactating women is a priority for countries such as Mozambique.…”

Optimizing the World Health Organization algorithm for HIV vertical transmission risk assessment by adding maternal self-reported antiretroviral therapy adherence

“…Since implementation of Option B+ strategy, [2] antiretroviral therapy (ART) coverage among pregnant women in eastern and southern Africa increased from 84 to 92% [3]. However, the goal of eliminating new paediatric infections by 2030 [4] will likely be compromised by multiple challenges in the VT-prevention cascade, including access to adequate postnatal prophylaxis among HIV-exposed infants [1,[5][6][7][8][9][10][11].…”