Adherence to early infant diagnosis of HIV testing protocol among HIV exposed infants in Buvuma Islands, Buvuma District, Uganda

Abstract

Introduction Early detection of paediatric human immunodeficiency virus (HIV) through deoxyribonucleic acid polymerase chain reaction (DNA PCR) and rapid HIV testing is critical for access to antiretroviral therapy treatment (ART) and child survival. In June 2012, Uganda’s Ministry of Health (MoH) adopted Option-B plus, a strategy where all HIV-positive pregnant and lactating mothers are started on ART irrespective of their clinical or immunological stage in order to eliminate mother to child transmission (e-MTCT) of HIV. Whereas EID tests are critical for informing the initiation of appropriate lifesaving treatment for infants born to HIV positive mothers, only 55% of HEIs underwent viral DNA PCR testing for HIV within 2 months of birth in 2017 in Uganda. In addition, information regarding adherence to EID of HIV testing protocol in hard to reach fishing communities like Buvuma islands remains scanty. Therefore, this study was conducted with the main objective of determining adherence to EID of HIV testing protocol and factors associated with non-adherence to 1st DNA PCR in Buvuma islands, Buvuma district. This study also sought to understand the barriers and facilitators of adherence to EID testing protocol. Methods A cross- sectional study employing both qualitative and quantitative methods of data collection was conducted among HEIs in Buvuma islands, Buvuma district. Secondary data was obtained from mother baby pair files using a data extraction tool. Quantitative data was analysed using STATA Version 14. Qualitative data was collected from mothers of HEIs and some health workers involved in the provision of EID services in the district. Qualitative interviews were audio recorded and later transcribed verbatim. Thematic approach was employed for analysis using ATLAS Ti version 8. Results None of the HEIs had done all the EID tests of HIV testing protocol within the recommended time frame for the period of January 2014- December 2016. Adherence to the 1st and 2nd DNA PCR, and rapid HIV tests was 39.5%, 6.1% and 81.0% respectively. The factors associated with non-adherence to the 1st PCR included infants being under the care of single mothers (PRR 1.11, 95% CI: 1.01-1.23, p=0.023) and cessation of breast feeding (PRR 0.90, 95% CI: 0.83-0.98, p=0.025). Maternal facilitators to adherence to EID testing protocol included; the desire to have an HIV negative child; and peer support while the health care facility facilitators included availability of monitoring tools for EID; health care providers’ support and counsel, and positive attitude of health care providers. Individual barriers included mobile nature of the fishing community, low socio-economic status and lack of transport while health facility barriers included inadequate facilitation for sample transportation, heavy workload and long waiting hours. Conclusion and recommendations There was non-adherence to the EID testing protocol among HEIs in Buvuma Islands. Therefore, there is need to sensitise health care providers and mothers of HEIs on the importance of adhering to the EID of HIV testing protocol.