Associations of Sociodemographic and Clinical Factors with Late Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya.

International Journal of MCH and AIDS Pub Date : 2021-01-01 Epub Date: 2021-12-13 DOI:10.21106/ijma.537
Agnes Langat, Tegan L Callahan, Isabella Yonga, Boniface Ochanda, Anthony Waruru, Lucy W Ng'anga, Abraham Katana, Brian Onyango, Benson Singa, Stephen Oyule, George Githuka, Lennah Omoto, Jane Muli, Thorkild Tylleskar, Surbhi Modi
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引用次数: 2

Abstract

Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya.

Methods: We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President's Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing.

Results: Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity.

Conclusion and global health implications: Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines.

Abstract Image

社会人口学和临床因素与肯尼亚早期婴儿HIV诊断(EID)服务迟报的关联。
背景:了解在预防母婴传播规划中婴幼儿早期艾滋病毒检测中错过的机会对于解决任何差距至关重要。该研究旨在描述肯尼亚早期婴儿诊断较晚的婴儿的临床和社会人口学特征。方法:在一项横断面研究中,我们提取了2016年10月至2018年9月期间1,346家总统艾滋病紧急救援计划(PEPFAR)支持的医疗机构中聚合酶链反应(PCR)检测阳性的所有艾滋病毒感染婴儿的常规收集的临床和社会人口学特征。我们使用多变量逻辑回归来检验社会人口学和临床特征与晚期(出生后>2个月)婴儿HIV检测的关系。结果:在确诊的4011例HIV感染婴儿中,HIV诊断时的婴儿年龄中位数为3个月[四分位间距(IQR), 1-16个月],三分之二[2669例(66.5%)]在婴儿HIV检测时出现延迟。与婴儿检查迟到相关的因素有:母亲ANC未出席,调整优势比(aOR) 1.41(95%可信区间(CI) 1.18 -1.69);新产妇HIV诊断,aOR 1.45 (95%CI 1.24 -1.7);缺乏母体抗逆转录病毒治疗(ART), aOR 1.94, (95% CI 1.64 - 2.30)。在门诊就诊的婴儿中,发现感染艾滋病毒的婴儿的可能性很高(aOR 18.9;95% CI 10.2 - 34.9)和住院环境(aOR 12.2;95%可信区间为6.23-23.9),与分娩较晚的婴儿相比。结论及其对全球健康的影响:婴儿早期艾滋病毒检测方面的差距表明,需要增加孕产妇孕前艾滋病毒诊断、及时的产前护理、婴儿早期诊断服务、早期识别在怀孕或哺乳期间进行血清转化的母亲,以及改善门诊和住院环境中的艾滋病毒筛查。应通过实施国家预防母婴传播准则,加强社区的早期转诊和利用卫生设施的机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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