proportion of hiv exposed infants aged 0-6 months who missed nevirapine prophylaxis admitted or attending the immunization clinic in mulago hospital.

Description

Background: Nevirapine prophylaxis has been found to lower the risk of HIV transmission in breast-fed infants. Its efficacy, safety and affordability make it the most preferred antiretroviral agent for paediatric prophylactic use in resource limited settings. While about 95% of pregnant and lactating mothers use ART in Uganda, only 42% of HIV exposed infants receive nevirapine prophylaxis. Therefore, there is a significant gap between the uptake of infant and maternal antiretroviral regimens. This study aimed to determine the proportion of HIV exposed infants who missed nevirapine prophylaxis and associated factors. Objective: To determine the proportion of HIV exposed infants (HEI) aged 0 to 6 months that missed nevirapine prophylaxis, establish the associated factors and document the number of HIV exposed infants who missed the nevirapine prophylaxis that are HIV infected. Methods: This was a cross-sectional study using mixed quantitative and qualitative methods of data collection. It was conducted at Mulago National Referral Hospital at acute care unit and in the immunisation clinic where a total of 228 mother infant pairs were enrolled. The proportion of HEI who missed nevirapine, the maternal, socio-economic, infant and health facility factors associated were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the proportion and factors associated with missing nevirapine prophylaxis. Key informant interviews were carried out in the PMTCT clinic with nine peer educators and seven health workers. Thematic analysis of qualitative data was done. Results: A total of 228 HIV exposed infants (HEI) were enrolled, 132/228 (57.9%) were male. The mean age of the infants was 4.0 months ± 0.3. Out of the 228 infants, 216 (94.7%) were born at term and 203 (89.0%) were born by spontaneous vertex delivery. HEI who missed nevirapine prophylaxis were 50 (21.9%). Factors significantly associated with HEI missing nevirapine prophylaxis included; delivery from outside government health facilities (AOR 8.41 95% CI; 3.22-21.99 p-value <0.001), mothers not undergoing PMTCT counselling (AOR 12.01 95% CI; 4.53-31.87 p-value <0.001), mothers not on ART (AOR 8.47 95% CI; 2.06-34.88 p-value 0.003) and mothers not having disclosed their HIV status to their partners (AOR 2.80 95% CI; 1.13-6.95 p-value 0.026). The HEI that missed nevirapine and were HIV infected were 35/50 (70.0%) (OR 0.67 95% CI; 0.54-0.80 p-value 0.001). Non-disclosure of HIV status to the partner and stigma were cited by key informants as major reason of HEI missing NVP prophylaxis.