Retention of HIV exposed infants in care at Arua regional referral hospital, Uganda: a retrospective cohort study

Apangu, Pontius; Izudi, Jonathan; Bajunirwe, Francis; Mulogo, Edgar; Bátwala, Vincent

doi:10.1186/s12889-019-6754-9

Cited by 4 publications

(1 citation statement)

References 38 publications

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“…Other studies with high LTFU include a Tanzanian study (61% LTFU) [31]. On the other hand, 72% of HIV-exposed infants remained in care after 12 months under option B+ in a study from Malawi [32], 81% under option B in Rwanda [33], and 79% after 18 months in Uganda [34], which is higher than in our study (Figure 3). Whereas these data illustrate the substantial problem of LTFU in VT prevention programmes, our study does not address the reasons for LTFU or potential solutions.…”

Section: Discussioncontrasting

confidence: 79%

Evolution of prevention of vertical HIV transmission in Uganda: 2008–2017

et al. 2022

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Objectives Uganda adapted its policy for prevention of vertical transmission (VT) of HIV transmission as the World Health Organization released Options A, B and B+. We assessed trends in diagnostic testing, breastfeeding practices, maternal and infant antiretroviral therapy (ART), mortality, VT and HIV‐free survival (HFS) among Ugandan infants born to women living with HIV during this period of successive guideline changes. Methods This is is a retrospective observational study of infants attending early infant diagnosis clinics at two Ugandan hospitals. Results A total of 1885 infants (48% female) were managed from 2009 to 2017. DNA polymerase chain reaction (PCR) for early infant diagnosis was performed on 1719 infants (92%, one or more PCR tests) and 676 infants (36%, two PCR tests). HIV serology was performed on 90 infants (4.8%). Testing increased over the study period but remained suboptimal, due to high loss to follow‐up (LTFU). A total of 93% of infants were breastfed, for a median of 9.5 months. The duration of breast milk exposure increased over the study period, consistent with guidelines that increasingly encouraged breastfeeding. Nine cases (0.48%) of suspected breast milk transmission were observed. The use of ART increased significantly over the study period. Mortality (3.5%, 2.7% and 1.1%; p = 0.0076) and VT (17%, 12% and 7.4%; p < 0.0001) decreased over the study period (2008–2010, 2011–2012 and 2013–2017, respectively). LTFU values were 31%, 49% and 59% at 6, 12 and 18 months of age, respectively, with only modest improvements over time. HFS could only be conclusively documented in 532 infants (28%) because of LTFU. Conclusions From 2009 to 2017, outcomes improved among HIV‐exposed infants in Uganda. LTFU remains a barrier to optimal care.

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Section: Discussioncontrasting

confidence: 79%

Evolution of prevention of vertical HIV transmission in Uganda: 2008–2017

et al. 2022

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Proportion of HIV exposed infants aged 0-6 months that missed nevirapine prophylaxis in Mulago National Referral Hospital, Uganda: a cross-sectional study

Hellen,

Joseph,

Ezekiel

et al. 2024

BMC Pediatr

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Background Nevirapine prophylaxis has been found to lower the risk of HIV transmission in breastfed infants. While about 95% of HIV positive pregnant and lactating mothers use Antiretroviral therapy in Uganda, a smaller percentage of HIV exposed infants (HEI) receive nevirapine (NVP) prophylaxis. This study aimed to determine the proportion of HEI who missed NVP prophylaxis and associated factors. Methods This was a cross-sectional study done using quantitative methods, conducted at Mulago National Referral Hospital (MNRH). A total of 228 mother-infant pairs were enrolled. The proportion of HEI who missed NVP, maternal, infant and health facility factors associated were determined using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the proportion and factors associated with missing NVP prophylaxis. Results The proportion of HEI who missed NVP prophylaxis was 50/228 (21.9%). Factors significantly associated with HEI missing NVP prophylaxis included delivery from outside government health facilities (AOR = 8.41; P = 0.001), mothers not undergoing PMTCT counselling (AOR = 12.01; P = 0.001), not on ART (AOR = 8.47; P = 0.003) and not having disclosed their HIV status to their partners (AOR = 2.80; P = 0.001). The HEI that missed nevirapine and were HIV positive were 35 (70.0%). The HEI that were HIV infected despite receiving nevirapine prophylaxis were 5 out of 40(12.5%). Conclusion One in five HEI missed NVP prophylaxis and nearly three quarters of those who missed NVP prophylaxis were HIV infected. Improving uptake of nevirapine by HEI will require interventions that can aid to strengthen PMTCT counselling.

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Proportion of HIV exposed infants aged 0-6 months that missed nevirapine prophylaxis in Mulago National Referral Hospital, Uganda: a cross-sectional study

Hellen

Rujumba

Mupere

et al. 2023

Preprint

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Background: Nevirapine prophylaxis has been found to lower the risk of HIV transmission in breast-fed infants. While about 95% of pregnant and lactating mothers use Antiretroviral therapy in Uganda, a smaller percentage of HIV exposed infants (HEI)receive nevirapine (NVP)prophylaxis. This study aimed to determine the proportion of HEI whomissed NVP prophylaxis and associated factors. Methods: This was a cross-sectional study done using quantitative methods. It was conducted at Mulago National Referral Hospital. A total of 228mother-infant pairs were enrolled.The proportion of HEI who missed NVP, maternal, infant and health facility factors associated were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the proportion and factors associated with missing NVP prophylaxis. Results: The proportion of HEI who missed NVP prophylaxis was 50/228(21.9%). Factors significantly associated with HEI missing NVP prophylaxis included; delivery from outside government health facilities [AOR=8.41 95% (CI 3.22-21.99)], mothers; not undergoing PMTCT counselling [AOR=12.01 95% (CI 4.53-31.87)],not on ART[AOR=8.47 95% (CI 2.06-34.88)] and not having disclosed their HIV status to their partners [AOR=2.80 95% (CI 1.13-6.95)].The HEI that missed nevirapine and were HIV positive were 35 (70.0%). Conclusion: One in five HEI missed NVP prophylaxis and nearly three quarters of those who missed NVP prophylaxis were HIV infected. Improving uptake of nevirapine by HEI will require interventions tostrengthen PMTCT counselling, assisted partner notification, reduction of HIV stigma and support to the private sector in the provision of PMTCT services.

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Retention of HIV exposed infants in care at Arua regional referral hospital, Uganda: a retrospective cohort study

Cited by 4 publications

References 38 publications

Evolution of prevention of vertical HIV transmission in Uganda: 2008–2017

Evolution of prevention of vertical HIV transmission in Uganda: 2008–2017

Proportion of HIV exposed infants aged 0-6 months that missed nevirapine prophylaxis in Mulago National Referral Hospital, Uganda: a cross-sectional study

Proportion of HIV exposed infants aged 0-6 months that missed nevirapine prophylaxis in Mulago National Referral Hospital, Uganda: a cross-sectional study

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