Determinants of early infant diagnosis and treatment of HIV among exposed infants in informal settlements in Nairobi, Kenya

Abstract

Background: Paediatric HIV infection is a growing health challenge, especially in sub-Saharan Africa. Most paediatric HIV infections are perinatally transmitted. Early Infant Diagnosis (EID) and immediate initiation of treatment minimizes deaths. Though EID services are widely available in Kenya, uptake remains low, especially in disadvantaged communities. Objectives: To evaluate determinants of EID and early treatment initiation among HIV exposed children from informal settlements in Nairobi, Kenya. Methodology: A descriptive cross sectional study was done; where HIV infected mother-infant pairs attending health care facilities were recruited. Consent was sought. Non-biological caretakers were excluded. Structured questionnaires were administered to obtain information on socio-demographics, knowledge and uptake ofEID, Prevention of Mother to Child Transmission (PMTCT) and Antiretroviral (ARV) therapy. Results: A total of 238 mother-infant pairs were interviewed. Majority, (69.2%) were aged below 30 years, 75% had below secondary level of education, 67.6% were married, and 71.4% were of poor social backgrounds. Most (77.4%) had HIV diagnosis made in the preceding year, 68.5% of them during pregnancy. Knowledge on importance of EID was poor, and only 53.8% had knowledge of PMTCT interventions. Only 38.7% had received ARV prophylaxis in pregnancy, while 37.4% were on ARV therapy. Majority, (63.5%) had delivered in a health facility, but only 56.7% had EID at 6 weeks. While 19.7% of infants tested HIV positive, only 10.6% of infected infants were started on treatment immediately. The main determinants of EID at 6 weeks were maternal delivery at a public health 74 East and Central Africa Medical Journal 2015; 2: 74-79 facility (p = 0.000, bR 0.171, CI 0.065- 0.451), receiving of psychosocial support (P = 0.000, OR 0.173, CI 0.075- 0.398), high matemaI knowledge on PMTCT (p =0.001), mothers on ARV therapy (P= 0.017, OR 0.284, CI 0.101- 0.795) and mother on ARV prophylaxis (p = 0.020, OR 0.306173, CI 0.113- 0.830). Factors associated with early initiation of treatment were delivery in public health (P=O.005) and receiving of psychosocial support (P=O.OOO). Conclusion: Knowledge of on PMTCT and EID was low, and this lead to low EID uptake. We recommend integration of PMTCT and paediatric HJV care services to MNCH settings.