Related Experiment Video
Updated: Jun 13, 2025
An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
Published on: March 30, 2014
Complete testing coverage for the early infant diagnosis algorithm and associated factors among infants exposed to
Rebecca Akunzirwe1, Julie R Harris2, Peter Chris Kawungezi1
1Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda.
Insights
Only half of infants exposed to HIV completed early infant diagnosis (EID) testing. Addressing maternal stigma and sexual violence may improve testing coverage for HIV-positive infants.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Early infant diagnosis (EID) is crucial for initiating HIV care in infants exposed to HIV (IEH).
- Uganda faces significant challenges with loss to follow-up (LTFU) in the EID program.
- This study assesses complete testing coverage (CTC) for the EID algorithm and its associated factors in Uganda.
Purpose of the Study:
- To evaluate the complete testing coverage (CTC) of the EID algorithm among infants exposed to HIV (IEH) in Uganda.
- To identify factors associated with achieving complete testing coverage for early infant diagnosis.
Main Methods:
- Prospective cohort study analyzing data from 1,804 infants exposed to HIV (IEH) from 2017-2019.
- Complete testing coverage (CTC) defined as adherence to EID testing algorithm at designated time points.
- Modified Poisson regression used to identify factors associated with CTC.
Main Results:
- 53% of infants achieved complete testing coverage (CTC) according to the EID algorithm.
- Maternal experiences of perceived discrimination, fewer pregnancies, and sexual violence were associated with lower CTC.
- 40 (2%) infants tested HIV-positive during the study.
Conclusions:
- Approximately half of infants exposed to HIV met the criteria for complete testing coverage.
- Interventions targeting maternal stigma and sexual violence could enhance EID testing adherence.
- Further research is needed to explore the links between sexual violence, parity, and EID CTC.
Background:
Early infant diagnosis (EID) facilitates early initiation into HIV care for identified HIV-positive infants. According to the Uganda Ministry of Health, EID testing algorithm, testing for infants exposed to HIV (IEH) should occur at <6 weeks, 9 and 18 months of age, and 6 weeks after stopping breastfeeding. Uganda has faced challenges with loss to follow-up (LTFU) of IEH for EID. We assessed complete testing coverage (CTC) to the EID algorithm for IEH and associated factors.
Methods:
We analyzed data from the 'Impact of the National Program for the Prevention of Vertical Transmission (PVT) of HIV in Uganda (2017-2019)' study. Mothers living with HIV whose infants tested HIV-negative at 4-12 weeks were enrolled in a prospective cohort (2017 - 2018) and followed until the IEH tested positive, died, was LTFU, or reached 18 months of age. We computed the proportion of IEH tested according to the EID algorithm among surviving infants. CTC was defined as undergoing HIV tests at three designated time points (excluding the 6 weeks after breastfeeding cessation) if HIV negative. IEH who were diagnosed with HIV but were tested at all recommended tests until that point were also considered to have CTC. We evaluated factors associated with CTC using modified Poisson regression.
Results:
Among 1,804 IEH, 912 (51%) were male. Of the 1,804 IEH at baseline, 27 (1%) died. Among the 1,777 IEH included in the primary outcome analysis, 1,282 (72%) completed the study and 941 (53%) infants had CTC according to the EID testing algorithm including 40 (2%) who tested HIV-positive. Perceived discrimination due to HIV status [RR = 0.77, 95%CI (0.65-0.92)], having fewer pregnancies [RR = 0.97, 95%CI (0.68-0.99)], and reporting sexual violence [RR = 0.82, 95%CI (0.73-0.93)] by the mother of IEH were associated with non-CTC.
Conclusion:
About half of IEH were tested at the recommended time points. Interventions to address stigma and sexual violence for mothers may improve CTC for the EID algorithm. Investigations are needed to explore associations between sexual violence, parity, and CTC for the EID algorithm.
