title: Missed opportunities for early infant HIV diagnosis: results of a national study in South Africa.
abstract: BACKGROUND
  Services to diagnose early infant HIV infection should be offered at the 6-week immunization visit. Despite high 6-week immunization attendance, the coverage of early infant diagnosis (EID) is low in many sub-Saharan countries. We explored reasons for such missed opportunities at 6-week immunization visits.
  
  
  METHODS
  We used data from 2 cross-sectional surveys conducted in 2010 in South Africa. A national assessment was undertaken among randomly selected public facilities (n = 625) to ascertain procedures for EID. A subsample of these facilities (n = 565) was revisited to assess the HIV status of 4- to 8-week-old infants receiving 6-week immunization. We examined potential missed opportunities for EID. We used logistic regression to assess factors influencing maternal intention to report for EID at 6-week immunization visits.
  
  
  RESULTS
  EID services were available in >95% of facilities and 72% of immunization service points (ISPs). The majority (68%) of ISPs provide EID for infants with reported or documented (on infant's Road-to-Health Chart/booklet-iRtHC) HIV exposure. Only 9% of ISPs offered provider-initiated counseling and testing for infants of undocumented/unknown HIV exposure. Interviews with self-reported HIV-positive mothers at ISPs revealed that only 55% had their HIV status documented on their iRtHC and 35% intended to request EID during 6-week immunization. Maternal nonreporting for EID was associated with fear of discrimination, poor adherence to antiretrovirals, and inadequate knowledge about mother-to-child HIV transmission.
  
  
  CONCLUSIONS
  Missed opportunities for EID were attributed to poor documentation of HIV status on iRtHC, inadequate maternal knowledge about mother-to-child HIV transmission, fear of discrimination, and the lack of provider-initiated counseling and testing service for undocumented, unknown, or undeclared HIV-exposed infants.
authors.affiliation: *Health Systems Research Unit, Medical Research Council, South African Medical Research Council, Parrowvallei, Cape Town, South Africa; †School of Public Health, University of the Western Cape, Bellville, South Africa; ‡UNICEF, New York, NY, USA; §Department of Paediatrics and Child Health, Kalafong Hospital, University of Pretoria, Pretoria, South Africa; ‖ELMA Philanthropies, New York, NY, USA; ¶School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; #Centers for Disease Control and Prevention, Pretoria, South Africa; **Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, GA, USA; ††Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa; and ‡‡Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Selamawit A
authors.initials: SA
authors.lastname: Woldesenbet
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.forename: Ameena E
authors.initials: AE
authors.lastname: Goga
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crowley
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.forename: Mary M
authors.initials: MM
authors.lastname: Mogashoa
authors.forename: Thu-Ha
authors.initials: TH
authors.lastname: Dinh
authors.forename: Gayle G
authors.initials: GG
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008297:Male; D013019:South Africa; D055815:Young Adult