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Predictors of Successful Early Infant Diagnosis of HIV in a Rural District Hospital in Zambézia, Mozambique

Cook, Rebecca E MSc*; Ciampa, Philip J MD, MPH*†§‖; Sidat, Mohsin MD, PhD; Blevins, Meridith MS; Burlison, Janeen MPH, MSN, WHNP-BC*†; Davidson, Mario A PhD; Arroz, Jorge A MD††; Vergara, Alfredo E PhD*†**; Vermund, Sten H MD, PhD*†§; Moon, Troy D MD, MPH*†§

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 2011 - Volume 56 - Issue 4 - p e104-e109
doi: 10.1097/QAI.0b013e318207a535
Implementation and Operational Research: Epidemiology and Prevention

Background: A key challenge inhibiting the timely initiation of pediatric antiretroviral treatment is the loss to follow-up of mothers and their infants between the time of mothers' HIV diagnoses in pregnancy and return after delivery for early infant diagnosis of HIV. We sought to identify barriers to follow-up of HIV-exposed infants in rural Zambézia Province, Mozambique.

Methods: We determined follow-up rates for early infant diagnosis and age at first test in a retrospective cohort of 443 HIV-infected mothers and their infants. Multivariable logistic regression models were used to identify factors associated with successful follow-up.

Results: Of the 443 mother-infant pairs, 217 (49%) mothers enrolled in the adult HIV care clinic, and only 110 (25%) infants were brought for early infant diagnosis. The predictors of follow-up for early infant diagnosis were larger household size (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09-1.53), independent maternal source of income (OR, 10.8; 95% CI, 3.42-34.0), greater distance from the hospital (OR, 2.14; 95% CI, 1.01-4.51), and maternal receipt of antiretroviral therapy (OR, 3.15; 95% CI, 1.02-9.73). The median age at first test among 105 infants was 5 months (interquartile range, 2-7); 16% of the tested infants were infected.

Conclusions: Three of four HIV-infected women in rural Mozambique did not bring their children for early infant HIV diagnosis. Maternal receipt of antiretroviral therapy has favorable implications for maternal health that will increase the likelihood of early infant diagnosis. We are working with local health authorities to improve the linkage of HIV-infected women to HIV care to maximize early infant diagnosis and care.

From the *Vanderbilt University Institute for Global Health, Nashville, TN; †Friends in Global Health, LLC, Maputo, Mozambique; ‡Universidade Eduardo Mondlane, Maputo, Mozambique; the Departments of §Pediatrics, ‖Medicine, ¶Biostatistics, and **Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN; and ††Zambézia Provincial Department of Health, Quelimane, Mozambique.

Received for publication August 5, 2010; accepted November 18, 2010.

The HIV/AIDS Treatment and Care program in Zambézia is supported by PEPFAR through the Centers for Disease Control and Prevention Global AIDS Program (grant U2GPS000631) with training supported in part by the Fogarty-sponsored Vanderbilt-CIDRZ AIDS International Training and Research Program (National Institutes of Health grant D43TW001035). Travel and other research expenses for this study were supported by the Office of the Dean, Vanderbilt University School of Medicine (the Emphasis Program). Funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Presented in part at the Global Health Council Conference, May 26-30, 2009 (Thursday Poster 34), Washington DC; and at the International AIDS Conference, July 18-23, 2010 (#10928), Vienna, Austria.

The authors have no conflicts of interest to disclose.

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Correspondence to: Alfredo E. Vergara, PhD, Vanderbilt University Institute for Global Health, 2525 West End Avenue, Suite 750, Nashville, TN 37203 (e-mail: alfredo.vergara@vanderbilt.edu).

© 2011 Lippincott Williams & Wilkins, Inc.