Predictors of Infant Age at Enrollment in Early Infant Diagnosis Services in Kenya.
Despite the importance of early detection to signal lifesaving treatment initiation for HIV+ infants, early infant diagnosis (EID) services have received considerably less attention than other aspects of prevention of mother to child transmission care. This study draws on baseline data from an on-going cluster randomized study of an intervention to improve EID services at six government hospitals across Kenya. Two logistic regressions examined potential predictors of "on time" (infant ≤6 weeks of age) vs. "late" (≥7 weeks) and "on time" versus "very late" (≥12 weeks) EID engagement among 756 mother-infant pairs. A quarter of the infants failed to get "on time" testing. Predictors of "on time" testing included being informed about EID by providers when pregnant, perceiving less HIV stigma, and mother's level of education. Predictors of "very late" testing (≥12 weeks of age) included not being informed about EID by providers when pregnant and living farther from services. Findings highlight the importance of ensuring that health care providers actively and repeatedly inform HIV+ mothers of the availability of EID services, reduce stigma by frequently communicating judgment free support, and assisting mothers in early planning for accessing EID services. Extra care should be focused on engaging mothers with less formal education who are at increased risk for seeking "late" EID testing. This study offers clear targets for improving services so that all HIV-exposed infants can be properly engaged in EID services, thus increasing the potential for the best possible outcomes for this vulnerable population.
Children's Mercy Hospitals and Clinics, Health Services and Outcomes Research, 2401 Gillham Road, Kansas City, MO, 64108, USA. kgoggin@cmh.edu.|University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA. kgoggin@cmh.edu.|University of Missouri-Kansas City, School of Pharmacy, Kansas City, MO, USA. kgoggin@cmh.edu.
Kathy
K
Goggin
University of Kansas Medical Center, Department of Family Medicine, Kansas City, KS, USA.
Catherine
C
Wexler
University of Kansas Medical Center, Department of Preventive Medicine, Kansas City, KS, USA.
Niaman
N
Nazir
Children's Mercy Hospitals and Clinics, Health Services and Outcomes Research, 2401 Gillham Road, Kansas City, MO, 64108, USA.|University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA.
Vincent S
VS
Staggs
Global Health Innovations, Kansas City, MO, USA.
Brad
B
Gautney
Kenya Medical Research Institute, Nairobi, Kenya.
Vincent
V
Okoth
Kenya Medical Research Institute, Nairobi, Kenya.
Samoel A
SA
Khamadi
Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
Andrea
A
Ruff
Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA.
Michael
M
Sweat
University of Missouri-Kansas City, School of Nursing and Health Studies, Kansas City, MO, USA.
An-Lin
AL
Cheng
University of Kansas Medical Center, Department of Family Medicine, Kansas City, KS, USA.
Sarah
S
Finocchario-Kessler
D000328:Adult; D003266:Continuity of Patient Care; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D016015:Logistic Models; D008297:Male; D009035:Mothers; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D057545:Social Stigma; D013997:Time Factors
EID; Global health; HIV/AIDS; Infants; PMTCT; Vertical prevention