RISK FACTORS ASSOCIATED WITH HIV INFECTION AMONG CHILDREN OF PMTCT CLINIC ATTENDEES IN FCT-ABUJA

Abstract

Elimination of Mother-to-child transmission (MTCT) of HIV is possible. Despite this, MTCT of HIV accounts for more than 90% of paediatric HIV cases. Few studies have examined the factors associated with the transmission of HIV within the primary health care delivery structure. This study was designed to investigate the factors associated with MTCT of HIV within the primary health care delivery structure of the FCT-Abuja. Five of the 6 Area Councils in the FCT were selected for this study, purposive sampling was used to select 12 of the 603 primary health care facilities in the FCT. A facility based unmatched case-control study was conducted among all HIV-exposed infants, a mixed method approach was adopted for data collection. A record review was used to determine the prevalence of MTCT of HIV in HIV-exposed infants. The exposures of interest studied were pharmacological interventions by the mother and infant, feeding options practiced, place of delivery, maternal age at index pregnancy, marital status, maternal literacy status, maternal employment status, maternal religion and parity. In-depth interviews were conducted with ten women whose infants tested positive to HIV to explore factors that may have increased the risk of MTCT of HIV. SPSS version 22.0 was used for analysis. The prevalence of MTCT of HIV was calculated, descriptive statistics were used to summarize quantitative variables, qualitative variables were summarized by proportions. Odds ratios and their 95% confidence intervals were calculated for independent variables; chi-square test was used to test for significance between variables. A p-value <0.05 was considered statistically significant. Variables that were significant in bivariate analyses were entered into a multiple logistic regression model. Audio recordings were transcribed; transcripts were analysed thematically. One hundred and twenty-eight (128) of one thousand, four hundred and seventy-one (1471) HIV-exposed infants were positive (period prevalence - 8.7%), mean age of mothers was 27.6 ± 5.5 years, 60.7% were between 21 - 30 years. At multivariate analysis, the non-use of ARV by infants [AOR 5.3 (95% CI 2.1 - 13.0)], ever breastfed [AOR 14.5 (95% CI 3.8 - 54.2)], been married at index pregnancy (AOR 0.2 (95% Cl 0.04 - 0.6)), non-use of ARV by the mother [AOR 14.1 (95% Cl 6.0 - 33.5)], home delivery [AOR 4.8 (95% Cl 1.6 - 14.3)] and CD4+ count less than 350 cells/mm3 [AOR 20.7 (95% CI 9.1 -46.7)] were predictors of MTCT of HIV. Amongst the in-depth interview participants' inadequate hospital service delivery hours and non-disclosure was cited as factors impeding the use of PMTCT interventions. PMTCT within the Primary Health Care structure is capable of reducing the risk of MTCT of HIV. In 402 mother - infant pairs studied in the Federal Capital Territory - Abuja, breastfeeding, home delivery, unmarried status, CD4+ count less than 350, nonuse of ARV by mother or/and infant were determined to be predictors of MTCT of HIV. Non-disclosure and inadequate hospital service delivery hours impedes the use of PMTCT services. Government should provide personnel to increase the uptake of PMTCT services such as hospital delivery. Health authorities should encourage HIV testing in male partners to address non-disclosure, which was central to the non-use of PMTCT interventions.