Factors associated with delayed HIV diagnosis in infants in tier three and four public health facilities in Kisumu county, Kenya

Abstract

Human Immunodeficiency Virus (HIV) is still a global challenge, with the bulk of infection in children being in sub-Saharan Africa. Six thousand six hundred and thirteen (6,613) new infections were reported in Kenya in 2015. In Kisumu County, HIV prevalence (19.9%) is 3.4 times higher than the national (5.9%). Prevention of Mother to Child Transmission (PMTCT) coverage in the County is low (60%) with 19.7% children infected in 2015. In 2016, only 3,369 infants were less than 2 months old among 6,209 infants who underwent initial HIV proviral DNA PCR testing. Consequently, probable HIV infected children who delayed HIV testing at 6 weeks of age were denied timely access to care and treatment. This has contributed to low (54%) coverage of care and treatment to eligible HIV infected children. This was a cross-sectional survey that sought to determine factors associated with delayed infant HIV diagnosis of seroexposed infants in tier three and four public health facilities in Kisumu County, Kenya. Specifically, it sought to establish the caregiver-infant factors associated with delayed infant HIV diagnosis, to determine the health worker factors associated with delayed infant HIV diagnosis and to find out the health facility organizational factors associated with delayed infant HIV diagnosis. The study was conducted within tier three (n=6) and four (n=1) public health facilities in Kisumu County, Kenya. Systematically sampled caregivers (n=224) of HIV exposed children attending their routine clinics at the facilities, all health workers (n=51) working in Maternal and Child Health (MCH) department and administrators (n=7) of the health facilities were interviewed. Data was collected using structured questionnaires and analyzed using chi-square, multiple logistic regression analysis and Student‟s t-test. Caregiver-infant factors associated with delayed infant HIV diagnosis in Kisumu County were: lack of knowledge about specific means of mother to child transmission (OR: 6.5, 95% CI: 1.7-25.0; p=0.006), home delivery (OR: 5.8, 95% CI: 2.1-16.0; p=0.001) and non-disclosure of infant HIV exposure status to non-relatives (OR: 6.9, 95% CI: 2.0-24.3; p=0.003). Among health workers, there was significant difference in work relationships score among health workers who attended to infants who delayed HIV diagnosis (M=4.0, SD=0.1) and those who did not delay (M=4.1, SD=0.1); t (222) =-2.89, p=0.004. In evaluation of health facility organizational factors, there was significant difference in scores among health workers who attended to infants who delayed HIV diagnosis and those who did not delay for: job targets score (M=76.1, SD=17.6 and M=81.8, SD=18.0 respctively); t(222) =-2.06, p=0.041, evaluation on targets score (M=71.3, SD=23.3 and M=80.6, SD=20.0 respectively); t(222) =-2.88, p=0.004, and feedback after evaluation score (M=67.0, SD=24.4 and M=78.3, SD=22.2 respectively); t(222) =-3.21, p=0.002. Other organizational factors that could further delay infant HIV diagnosis in Kisumu County include long distance to central testing laboratories from facilities, use of courier services for sample transport, physical paper based result delivery and use of clinic appointments to provide results to caregivers. HIV sensitization programs need to focus on various mechanisms of HIV transmission, reduction of HIV-related stigma and the concept of early infant HIV testing. Kisumu County government should target to increase hospital deliveries from the current 69.5%. Public health facilities should promote good inter-personal relationships between health workers and adopt human resources performance management cycle as a collaborative team self-management practice. Kisumu County should also adopt point of care testing for HIV proviral DNA PCR.