Barriers to uptake of early infant HIV testing in Zambia: the role of intimate partner violence and HIV status disclosure within couples.
BACKGROUND
Early detection of pediatric HIV through uptake of infant HIV testing is critical for access to treatment and child survival. While structural barriers have been well described, a greater understanding of social and behavioral factors that may relate to maternal uptake of early infant HIV testing services is urgently needed. The aim of this study was to explore how gender power dynamics within couples affect HIV-positive women's uptake of early infant HIV testing at a large health center in Lusaka, Zambia.


METHODS
In 2014, 320 HIV-positive married postpartum women were recruited at a large public health facility in Lusaka to participate in a cross-sectional survey. Data on uptake of early infant HIV testing by 4-6 weeks of age was collected through medical records. Simple and multiple logistic regression models determined significant predictors of maternal uptake of early infant HIV testing.


RESULTS
In the adjusted model, uptake of early infant HIV testing was associated with female-directed emotional intimate partner violence (aOR 0.41; 95% CI 0.21-0.79; p < 0.01), HIV status disclosure to the male partner (aOR 13.73, 95% CI 3.59-52.49, p < 0.001), and maternal postpartum ART adherence (aOR 2.28, 95% CI 1.15-4.55, p < 0.05).


CONCLUSIONS
Domestic relationship dynamics, including emotional violence and HIV status disclosure to the male partner, may play an important role in maternal uptake of early infant HIV testing. These findings provide additional evidence for the link between intimate partner violence against women and poor HIV-related health outcomes. Programs that adequately screen for and address various forms of intimate partner violence within the context of prevention of mother-to-child transmission are recommended.
Department of Community and Behavioral Health, Colorado School of Public Health, 13199 East Montview Boulevard, Suite 310, Mail Stop A090, Aurora, CO, 80045, USA. karen.hampanda@ucdenver.edu.
Karen M
KM
Hampanda
University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, 80045, USA.
Abigail M
AM
Nimz
Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.|Center for Global Health, University of Colorado School of Medicine School of Public Health, 13199 East Montview Boulevard, Suite 310, Mail Stop A090, Aurora, CO, 80045, USA.
Lisa L
LL
Abuogi
D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology / Q000635:transmission; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D000066511:Intimate Partner Violence / Q000523:psychology*; D008297:Male; D008393:Marriage; D008403:Mass Screening / Q000523:psychology; D013179:Spouse Abuse / Q000523:psychology*; D014342:Truth Disclosure; D015024:Zambia