Barriers to early infant diagnosis of HIV in the Wa Municipality and Lawra District of Upper West Region, Ghana

Knowledge of HIV transmission during pregnancy among women of reproductive age in Ghana

INTRODUCTION

Human immunodeficiency virus (HIV) remains a significant health challenge affecting many people including those from sub-Saharan Africa (SSA). Even though HIV can be transmitted through various means, mother-to-child transmission (MTCT) remains the major route of transmission in children under the age of five. This study examined the correlates of knowledge of HIV transmission during pregnancy among reproductive-age women in Ghana.

METHODS

Data for this study were obtained from the 2014 Ghana Demographic and Health Survey. The sample consisted of 9,106 women aged 15 to 49 years. We conducted both descriptive and multivariable logistic regression analyses to determine the prevalence and factors associated with knowledge of HIV transmission during pregnancy. The results were presented using frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding 95% confidence intervals (CI).

RESULTS

Approximately, 69.41% of women of reproductive age knew of HIV transmission during pregnancy. Women who had two (aOR = 1.32, 95% CI [1.01, 1.72]) or three (aOR = 1.37, 95% CI [1.07, 1.76]) births were more knowledgeable of HIV transmission during pregnancy. Women who read the newspaper (aOR = 1.56, 95% CI [1.31, 1.86]), listened to the radio (aOR = 1.23, 95% CI [1.05, 1.45]), lived in rural areas (aOR = 1.30, 95% CI [1.09, 1.54]) or ever been tested for HIV (aOR = 1.20, 95% CI [1.05, 1.37]) were more likely to be knowledgeable of HIV transmission during pregnancy than their counterparts in the reference categories. Compared to those in the Western Region, women in the Upper East (aOR = 0.45, 95% CI [0.32, 0.63]), Upper West (aOR = 0.54, 95% CI [0.35, 0.85]), Ashanti (aOR = 0.75, 95% CI [0.58, 0.97]) and Greater Accra Regions (aOR = 0.74, 95% CI [0.56, 0.98]) were less knowledgeable of HIV transmission during pregnancy.

CONCLUSIONS

The study highlights a gap in the knowledge of HIV transmission during pregnancy among women in Ghana. Continuous public education is required to educate women on HIV transmission from mothers to their children during pregnancy and how this may be interrupted. Such programs should involve the use of the media and take into consideration the demographic and geographic characteristics highlighted as determinants in this study. This will ultimately contribute to the reduction of MTCT of HIV in Ghana.

Caregivers' experiences of accessing HIV Early Infant Diagnosis (EID) services and its barriers and facilitators, India

BACKGROUND

India has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers' perspectives on barriers and facilitators to access and utilize EID services.

METHODS

The study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers' of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers' perspectives.

RESULTS

The stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade.

DISCUSSION

The study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers' perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors.

CONCLUSION

The study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services.

Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centers in Lagos State, Nigeria

INTRODUCTION

Nigeria has a low uptake of early infant diagnosis (EID) of HIV despite its high pediatric HIV infection rate. Efforts to increase the EID of HIV have been limited by many factors. This research assessed EID uptake and challenges service providers experienced in providing routine care for HIV-exposed infants.

METHODS

This is a mixed-method study at primary health centers (PHCs) in Lagos state, Nigeria. The quantitative component of the research was a review of the PMTCT Infant Follow-up Register at a purposive sample of 22 PHCs of Lagos State. The number of HIV-exposed infants (HEIs) returned for a dried blood sample (DBS) collection, date of collection, and the infant's EID results for one year preceding the study were captured on Research Electronic Data Capture (RedCap). In-depth interviews were conducted with service providers purposively selected per participating PHC. Electronic transcripts were analyzed using MAXQDA 2020 (VERBI Software, 2019).

RESULTS

Twenty-two Lagos State primary health centers participated in the research. Fifteen PHCs (68.2%) had PMTCT HIV counseling and Infant follow-up registers. Documentation of DBS sample collection was observed in 12 (54.6%) PHCs. Both DBS sample collection and EID results documentation were observed in only nine (40.9%) PHCs. In-depth interviews revealed both maternal and health systems' challenges to EID. The denial of HIV status was the only maternal factor reported as a barrier against the use of EID services. Health systems challenges include unavailability of EID services, uncertainty regarding whether EID is performed in a facility, referral to secondary health facilities for EID services (leading to losses to follow-up), and delay in getting results of EID. Task-shifting of DBS collection by nurses was suggested as means to increase access to EID services.

CONCLUSIONS

There is a need to expand EID services and address women's denial of HIV infection. Counseling women and linkage to available services are emphasized. Re-training of health workers on DBS collection and proper documentation of EID services were noted as key to improving the implementation of early infant diagnosis of HIV in the state.