Predictors of re-engagement into care of HIV exposed infants at Nakaseke hospital
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Background: In 2019, about 54% of HIV-exposed Infants (HEI) received HIV care worldwide. However, up to 30% of these children are reported as lost-to-follow-up (LTFU) from HIV care annually. Despite this, little has been done to re-engage those that are LTFU. Even then, efforts of re-engagement into HIV care have focused on adults but not children. The overall aim of this study was to determine the predictors of re-engagement into care of HEI at Nakaseke Hospital. Methods: This was a matched case-control study with mixed quantitative and qualitative methods. For the quantitative study, 1:2 frequency matching by distance from hospital and year of enrollment was done. Consecutive sampling was used to select 109 cases and 218 controls from all HEI enrolled at Nakaseke Hospital but were LTFU between January 2015 and December 2019. Characteristics of HEI LTFU and re-engaged in care (cases) were compared with those that were LTFU but were not re-engaged in care (controls) to identify predictors of re-engagement. For the qualitative study, care givers of HEI who were LTFU were invited for 20 in-depth interviews to explore reasons for initial LTFU and eventual failure to re-engage in HIV care and facilitators of re-engagement in care. Six key informant interviews were also held with health workers. Quantitative data were analyzed using conditional logistic regression while qualitative data were analyzed manually using thematic framework approach. Results: Majority (62.4%,n=68) of cases and controls (58.7%,n=108) were LTFU before six months and at 6-12 months respectively. Ninety-five percent (n=104) of cases and 97.83% (n=180) of controls had a negative 1st PCR. Having received their 1st PCR results before LTFU (Adjusted odds ratio [AOR]=6.94; Ninety-five percent confidence interval [95%CI]:1.63, 29.44), HEI being aged less than 6 months at LTFU (AOR=2.72; 95% CI:1.06,7.00), mothers of HEI being diagnosed with HIV before pregnancy (AOR=7.00; 95% CI:2.28,21.47) and having disclosed their HIV status (AOR=13.56; 95% CI:4.89,37.65) were significantly associated with re-engagement into HIV care. Economic empowerment of the mothers, efforts to trace HEI who are LTFU, social support, and health status of the baby were other reasons for re-engagement of HEI from the qualitative interviews. Long waiting time, poor attitude of health workers and perception that baby is fine were the reasons for eventual failure to re-engage HEI into HIV care. Conclusion: Early knowledge and disclosure of maternal HIV sero-status a reflection of good health seeking behavior is important if HIV exposed Infants are to be re-engaged into HIV care. Record of a telephone contact acts as a link between the health workers and the HEI aiding re-engagement into HIV care. Social and economic support to the mothers of the HEI are also important predictors in re-engaging HEI into HIV care however quality of care at the health facility remains a barrier for re-engagement of HEI. Recommendation: Health workers should emphasize disclosure of HIV status to significant others during counseling of HIV positive women. Health workers should endeavor to record telephone contacts of the caretakers of every HEI enrolled into HIV care to enable follow up. Ministry of health should intensify strategies to enhance early HIV diagnosis among pregnant women including increased sensitization for timely first ANC attendance among women of reproductive age. Ministry of health should implement strategies to reduce workload in the health facilities which is anticipated to improve quality of care.