Incidence and predictors of early and late HIV sero-conversion among HIV exposed infants In Oyam district, Northern Uganda.

Abstract

Introduction: Mother-to-child transmission of human immunodeficiency virus (HIV) remains a major source of HIV infection among children. Uganda has progressed towards eliminating vertical transmission of HIV though 95,000 children still acquire the infection annually through this exposure. This study aimed at determining the incidence and predictors of early and late HIV sero-conversion among HIV exposed infants (HEI) in Oyam district, Northern Uganda from January 2014 to December 2016. This is to support implementation of targeted interventions in eliminating HIV transmission among HEI. Methods: We sampled 520 HIV exposed infants (HEI) using probability proportionate sampling method from 1925 HEI enrolled into care in the 7 health facilities in Oyam district and retrospectively followed up for 18 months. The primary outcomes were HIV seroconversion among HEI categorized as early and late. Data were abstracted from early infant diagnosis (EID) registers, and mother/baby care appointment books at the health facilities. Predictors of early and late HIV sero conversion were analyzed using cox proportional hazards regression model using Stata version 14. Results: Infants were followed for 18 months. Overall incidence rate of HIV sero-conversion among HEI was 0.25 per 100 person-years. Incidence of early HIV sero-conversion was 0.13 per 100 person years and among late sero conversion was 0.12 per 100 person-years. The main predictors for early HIV sero-conversion included mothers’ poor adherence to highly active antiretroviral therapy (HAART) (HR: 3.73, 95% CI: 1.84 – 7.58, P-value: <0.001)) and babies who missed appointments during EID reviews (HR: 0.41 95%CI: 0.22 – 0.79, P-value: 0.007). Babies who did not receive nevirapine (NVP) (HR: 4.99, 95% CI: 1.12 – 11.75, P-value: <0.001), cotrimoxazole (CTX)HR: 2.59, 95% CI: 1.08 – 6.24, P-value: 0.033) and ensuring good xiii nutrition (HR: 0.38, 95%CI: 0.19 – 0.75, P-value: 0.005) to improve the birth weight babies are critical in averting sero-conversion after 6 months of age. Conclusion: The overall incidence of HIV seroconversion among HEI was found higher than national average. This was noted higher among HEI before 6 months than after 6 months. From this study, ensuring early initiation of nevirapine, giving cotrimoxazole appropriately and good nutrition to improve the birth weight are critical in averting late HIV sero-conversion. Adherence to ART for mothers and infants is key in reducing early HIV seroconversion. We recommend robust programs to improve ART initiation and adherence for mothers early in ANC and ensure frequent follow ups for the HEI during the program.