Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambézia, Mozambique.
BACKGROUND
A key challenge inhibiting the timely initiation of pediatric antiretroviral treatment is the loss to follow-up of mothers and their infants between the time of mothers' HIV diagnoses in pregnancy and return after delivery for early infant diagnosis of HIV. We sought to identify barriers to follow-up of HIV-exposed infants in rural Zambézia Province, Mozambique.


METHODS
We determined follow-up rates for early infant diagnosis and age at first test in a retrospective cohort of 443 HIV-infected mothers and their infants. Multivariable logistic regression models were used to identify factors associated with successful follow-up.


RESULTS
Of the 443 mother-infant pairs, 217 (49%) mothers enrolled in the adult HIV care clinic, and only 110 (25%) infants were brought for early infant diagnosis. The predictors of follow-up for early infant diagnosis were larger household size (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09-1.53), independent maternal source of income (OR, 10.8; 95% CI, 3.42-34.0), greater distance from the hospital (OR, 2.14; 95% CI, 1.01-4.51), and maternal receipt of antiretroviral therapy (OR, 3.15; 95% CI, 1.02-9.73). The median age at first test among 105 infants was 5 months (interquartile range, 2-7); 16% of the tested infants were infected.


CONCLUSIONS
Three of four HIV-infected women in rural Mozambique did not bring their children for early infant HIV diagnosis. Maternal receipt of antiretroviral therapy has favorable implications for maternal health that will increase the likelihood of early infant diagnosis. We are working with local health authorities to improve the linkage of HIV-infected women to HIV care to maximize early infant diagnosis and care.
Vanderbilt University Institute for Global Health, Nashville, TN 37203, USA.
Rebecca E
RE
Cook
Philip J
PJ
Ciampa
Mohsin
M
Sidat
Meridith
M
Blevins
Janeen
J
Burlison
Mario A
MA
Davidson
Jorge A
JA
Arroz
Alfredo E
AE
Vergara
Sten H
SH
Vermund
Troy D
TD
Moon
D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009073:Mozambique; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D012424:Rural Population
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