Conference abstract

Risk of HIV positivity in exposed infants associated with different interventions, Uganda, 2016

Pan African Medical Journal - Conference Proceedings. 2017:6(24).21 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.24.506

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Keywords: HIV seropositivity, infants, risk, Uganda
Plenary

Risk of HIV positivity in exposed infants associated with different interventions, Uganda, 2016

Paul Edward Okello1,&, Daniel Kadobera1, Alex Riolexus Ario1

1Uganda Public Health Fellowship Program, Kampala, Uganda

&Corresponding author
Paul Edward Okello, Uganda Public Health Fellowship Program, Kampala, Uganda

Abstract

Introduction: a pregnant woman who is HIV positive can transmit the virus to the baby during pregnancy, labour, birth, and breastfeeding; the likelihood ranging from 15% to 45% without antiretroviral treatment and highest in breastfeeding situations. The Early Infant Diagnosis program of the Uganda Ministry of Health is responsible for the diagnosis of HIV in infants and children at the earliest possible opportunity, usually any time from 6 weeks from birth. Diagnosis of HIV in infants and mothers should be followed by prompt ART initiation under the policy of Elimination of Mother to Child Transmission of HIV.

Methods: the report covers the period of January to December 2015 in which blood samples from infants and children were collected nationwide and tested for HIV infection from the molecular Biology laboratories at the Central Public Health Laboratories in Kampala. The test method of HIV–1 DNA PCR was used to test specimens comprising dried blood spots on filter paper. Bivariate analysis using cross-tabulation of dependent (health outcome) and independent variables (exposure factors) generated crude risk ratios which were used to interpret the likelihood of HIV infection in exposed infants. Significant factors at the bivariate level were subjected to multiple logistic regression models to correct for confounding factors and to generate adjusted odds ratios of HIV infection in the exposed infants.

Results: monthly, infant HIV positivity rates varied from 4% to 5.5% and were lower towards the end of the year. The distribution of the positivity rates across the country varied from 4% to 8% and was higher around the Central and the Eastern regions. At least 50% of the children tested at PCR1 (first testing) were 2 months of age, the rest testing later than scheduled. HIV positivity rates also increased with the age of the child. Children born to mothers on life-long ART at antepartum (AOR = 0.11, 95% CI 0.09 - 0.12) and intrapartum (AOR = 0.16, 95% CI 0.14 - 0.18) were less likely to be HIV positive. Infants on the recommended ARV prophylaxis of daily nevirapine from birth to 6 weeks were less likely to be HIV positive (AOR=0.19, 95% CI 0.17-0.21) especially when the mother is on life-long ART.

Conclusion: breastfeeding was protective for the infant (AOR = 0.34, 95% CI 0.28 - 0.41) if the mother was on life-long ART postpartum, but posed risks of HIV infection for the child (AOR = 2.71, 95% CI 2.39 - 3.09) if the mother was ARV na´ve postpartum. Children born to ARV na´ve mothers were more likely to be HIV positive (AOR = 6.18, 95% CI 5.46 - 6.99), and children who were never given ARV prophylaxis were more likely to be HIV positive (AOR = 7.62, 95% CI 6.89 - 8.44). Test results turn-around times, were longest for the process of specimen collection at the health facility and delivery to the central testing lab (10 - 12 days), and shortest for specimen reception and testing (2 days). The use of ART by mothers and infants should be stepped up, and there is need to reduce the number of children testing late for HIV infection.