Factors associated with HIV infection in 6-8 week old infants in Swaziland
Date
2019
Authors
Mirira, Linda
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Abstract
Background: Mother-to-child transmission of the Human Immunodeficiency Virus (HIV) is a major cause for increased child morbidity and mortality in sub-Saharan Africa. Prevention of Mother to Child Transmission (PMTCT) programmes have been linked with significant reductions in vertical HIV transmissions resulting in low morbidity and mortality proportions in infants. However, a number of barriers continue to pose significant programme challenges that hinder the eradication of mother-to-child transmission of HIV. Literature on factors which are associated with HIV PCR positivity in infants aged 6-8 weeks in Swaziland is limited. It is against this background that we undertook the study to determine the factors associated with Polymerase Chain Reaction (PCR) positivity in HIV exposed infants at 6-8 weeks in Swaziland. Study Aim: To determine factors associated with PCR positivity in HIV exposed infants aged 6-8 weeks who were attending child welfare clinics in Swaziland. Methodology: The study utilised secondary data analysis collected on mother-infant pairs during the period of 2011 and 2012 to assess the efficiency of the PMTCT programme in Swaziland by the Health Management Information System department under the Ministry of Health. Study sample consisted of 1699 HIV infected mothers and their 6-8 week old infants. The study outcome was HIV PCR positivity at 6-8 weeks of age. Factors associated with PCR positivity among infants who were exposed to HIV were determined using univariate and multivariable logistic regression methods. Results: Of the 1699 exposed infants, only 1415 were evaluated since 284 had missing data on the PCR outcome. The results revealed that 31infants were HIV PCR positive at 6-8 weeks, reflecting a mother-to-child transmission rate of 2.2%. Maternal age, number of antenatal care visits, maternal antiretroviral regimen, place of delivery and birth weight were significantly associated with HIV PCR positivity at 6-8 weeks in the univariate model. However, number of antenatal care visits remained significantly associated with HIV PCR positivity in the multivariable regression model, after controlling for other factors. In particular, infants of mothers who had attended more than four visits were less likely to be PCR positive at 6-8 weeks as compared to infants whose mothers had less than four visits (OR = 0.83; 95% CI: 0.02, 0.44; p-value = 0.004). Conclusion: Increased number of antenatal care visits attended by pregnant women is beneficial because it increases access to PMTCT services thereby decreasing the prospects of mother-to-child HIV transmission. Existing public health programmes that target the eradication of mother-to-child HIV transmission should improve access and strengthen antenatal care services so as to eliminate PCR positivity in infants exposed to HIV at 6-8weeks.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, In partial fulfilment of the requirements for the degree of MSc (Med) in the field of Child Health (Community Paediatrics) March 2019