Abstract:

Over 1.2 million newborns are exposed to HIV annually, with Zambia contributing significantly due to its 21% HIV prevalence among pregnant women. Testing exposed infants is crucial for early diagnosis. This study utilized a case-control design study to evaluate the effectiveness of the Electronic Health Exposed Infant Monitoring tool in improving Early Infant Diagnosis services in the Kabwe and Chibombo districts of Zambia. Our study was conducted across 16 health facilities involving 248 infant-mother pairs aged 0 to 2 months. Of these, 163 pairs were enrolled into the EHEI_Mt system, while 85 pairs continued being tracked by the existing standard system. Both groups were monitored for 12 months using the electronic tool and Ministry of health standard systems. Descriptive analysis with Pearson Chi2-test was done to determine associations between the use of a tracking system for HIV Exposed infants and other explanatory variables. A stepwise, backward logistic regression model was fitted to predict factors associated with early infant diagnosis uptake. All analyses were done using STATA version 25 (Stata Corp, US Texas. No mother-related factors were significantly associated, but babies in the EHEI_Mt Tool group were more likely to keep appointments (p < 0.001), with 73% having a known HIV outcome compared to 22% in the Standard group. We recommend standalone electronic systems as a reminder for healthcare workers for better infant tracking and adherence. Further research on HIV-positive mothers ' perceptions of current early infant diagnosis health systems is needed to address gaps in the PMTCT program for improved outcomes.

References:

[1].   Joint United Nations Programme on HIV/AIDS. (2023). Global report: UNAIDS report on the global AIDS epidemic. Geneva. Retrieved from http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf.

[2].   Joint United Nations Programme on HIV/AIDS. (2010). Zambia country report: Monitoring the Declaration of Commitment on HIV and AIDS and the universal access: Biennial report. Geneva. Retrieved from http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedbycountries/zambia_2010_country_progress_report_en.pdf.

[3].   Finocchario-Kessler, S., Goggin, K., Khamadi, S., Gautney, B. (2015). Improving early infant HIV diagnosis in Kenya: Study protocol of a cluster-randomized efficacy trial of the HIT System. Implementation Science, 10, 96. https://doi.org/10.1186/s13012-015-0284-3.

[4].   Ministry of Health, Zambia. (2020). Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection 2020. Retrieved from https://www.moh.gov.zm/wp-content/uploads/filebase/Zambia-Consolidated-Guidelines-for-Treatment-and-Prevention-of-HIV-Infection-2020.pdf.

[5].   Ministry of Health, Zambia. (2023). National Health Strategic Plan for Zambia 2022 to 2026 (Revised February 2023) [PDF]. Retrieved from https://www.moh.gov.zm/wp-content/uploads/2023/02/National-Health-Stratergic-Plan-for-Zambia-2022-to-2026-revised-February-2023-lower-resolution.pdf.

[6].   Ahoua, L., Arikawa, S., Tiendrebeogo, T., Lahuerta, (2020). Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programs: The Mozambique experience. BMC Public Health, 20(1), 322.https://doi.org/10.1186/s12889-020-8406-5.

[7].   Gumede-Moyo, S., Todd, J., Bond, V., Mee, P., & Filteau, S. (2019). A qualitative inquiry into implementing an electronic health record system (SmartCare) for prevention of mother-to-child transmission data in Zambia: A retrospective study. BMJ Open, 9(9), e030428.https://doi.org/10.1136/bmjopen-2019-030428.

[8].   Measure Evaluation. (2019). Testing a PMTCT Tracker in Zimbabwe_tr-19-333 [Technical Report]. Retrieved from https://www.measureevaluation.org/resources/publications/tr-19-333/at_download/document.

[9].   Brown, M., Wexler, C., Gautney, B., Goggin, K., Hurley, E. A., Odeny, B., Maloba, M., Lwembe, R., Sandbulte, M., & Finocchario-Kessler, S. (2019). eHealth Interventions for Early Infant Diagnosis: Mothers' Satisfaction with the HIV Infant Tracking System in Kenya. AIDS and Behaviour, 23(11), 3093-3102. doi:10.1007/s10461-019-02579-5.

[10].  Dunning, L., Kroon, M., Fourie, L., Ciaranello, A., & Myer, L. (2017). Impact of Birth HIV-PCR Testing on the Uptake of Follow-up Early Infant Diagnosis Services in Cape Town, South Africa. Paediatric Infectious Disease Journal, 36(12), 1159-1164.doi: 0.1097/INF.0000000000001677.

[11].  Ankunda, R., Cumber, S. N., Atuhaire, C., Kabanda, T., Nkfusai, C. N., Wirsiy, F. S., & Turyakira, E. (2020). Loss to follow-up and associated maternal factors among HEIs at the Mbarara Regional Referral Hospital, Uganda: A retrospective study. BMC Infectious Diseases, 20(1), 235. doi: 10.1186/s12879-020-04964-1.

[12].  Mute, T., Akondé, A., & Doumbia, A. (2011). The prevention of mother-to-child transmission of HIV-1 in Mali HIV-1-positive pregnant women and loss to follow-up in the Segou region. 6th IAS Conference on HIV Pathogenesis and Treatment Abstract no. MOPE480.

[13].  Nyandiko, W. M., Otieno-Nyunya, B., Musick, B., Bucher-Yiannoutsos, S., Akhaabi, P., Lane, K., Yiannoutsos, C. T., & Wools-Kaloustian, K. (2010). Outcomes of HIV-exposed children in western Kenya: Efficacy of prevention of mother to child transmission in a resource-constrained setting. Journal of Acquired Immune Deficiency Syndromes, 54(1), 42-50. doi: 10.1097/QAI.0b013e3181d8ad51.

[14].  Ebonwu, J., Mumbauer, A., Uys, M., Wainberg, M. L., & Medina-Marino, A. (2018). Determinants of late antenatal care presentation in rural and peri-urban communities in South Africa: A cross-sectional study. PLoS ONE, 13(3), e0191903.

[15].  Tesfaye, G., Loxton, D., Chojenta, C., Semahegn, A., & Smith, R. (2017). Delayed initiation of antenatal care and associated factors in Ethiopia: A systematic review and meta-analysis. Reproductive Health, 14(1), 1–17.

[16].  Nikhare, K., Gawde, N., Kamble, S., et al. (2024). Caregivers’ experiences of accessing HIV Early Infant Diagnosis (EID) services and its barriers and facilitators, India. BMC Health Services Research,24(1), 24. https://doi.org/10.1186/s12913-023-10500-z.

[17].  Kiilu, E. M., Karanja, S., & Kikuvi, G. P. W. (2019). Caregiver factors influencing seeking of Early Infant Diagnosis (EID) of HIV services in selected hospitals in Nairobi County, Kenya: A Qualitative Study. International Journal of Scientific and Research Publications, 9(4). https://doi.org/10.29322/IJSRP.9.04.2019.p8825.

[18].  Adeniyi, V. O., Thomson, E., Goon, D. T., & Ajayi, I. A. (2015). Disclosure, stigma of HIV positive child and access to early infant diagnosis in the rural communities of OR Tambo District, South Africa: A qualitative exploration of maternal perspective. BMC Pediatrics, 15(1), 98. https://doi.org/10.1186/s12887-015-0414-8.

[19].  Kalembo, F. W., Zgambo, M., Mulaga, A. N., Yukai, D., & Ahmed, N. I. (2012). Association between household socioeconomic status and adherence to exclusive breastfeeding among HIV-exposed infants in Malawi. World Journal of AIDS, 2(2), 195-200. https://doi.org/10.4236/wja.2012.22025.

[20].  Kreitchmann, R., Harris, D. R., Kakehasi, F., Haberer, J. E., Cahn, P., Losso, M., ... & Read, J. S. (2012). Loss to follow-up among HEIs in Latin America and the Caribbean: the NISDI Pediatric Study. International Journal of Infectious Diseases, 16(12), e935-e941. https://doi.org/10.1016/j.ijid.2012.07.023.

[21].  Cook, R. E., Ciampa, P. J., Sidat, M., Blevins, M., Burlison, J., Davidson, M. A., ... & Moon, T. D. (2011). Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambezia, Mozambique. Journal of Acquired Immune Deficiency Syndromes (1999), 56(4), e104-e109. https://doi.org/10.1097/QAI.0b013e3182047c97.

[22].  Bazira, J., Apio, K., Kyambadde, M., Nakawungu, R., Nduhuura, D., Ayebarirwe, M., Orikiriza, P., & Kumbakumba, E. (2022). Good Utilization, Low Completion Rates of Early Infant HIV Diagnostic Services at a District Hospital in Rural, Southwestern Uganda. https ://doi.org/10.21203/rs.3.rs-1342532/v1.

[23].  Odekunle, F. F., Adekunle, R. O., & Shankar, S. (2017). Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region. International Journal of Health Sciences, 11, 59-64.

[24].  Modi, S., Callahan, T., Rodrigues, J., Kajoka, M. D., & Dale, H. M. (2017). Overcoming Health System Challenges for Women and Children Living with HIV Through the Global Plan. Journal of Acquired Immune Deficiency Syndromes, 75(Suppl1)S76-S85. doi:10.1097/QAI.0000000000001336.

[25].  World Health Organization. (2018). Prevention of mother-to-child transmission of HIV: Technical update. Retrieved from https://www.afro.who.int/sites/default/files/2018-06/Prevention%20of%20mother-to-child%20transmission%20-%20Technical%20update.pdf.

[26].  Simbaya, J., Funjika, P., Moonga, A., Mwale, J., & Kankasa, C. (2021). Feasibility of using infant testing during immunization to estimate HIV mother-to-child transmission rates in Zambia. BMC Infectious Diseases, 21(1), 1239. doi: 10.1186/s12879-021-06892-0.

[27].  Dunning, L., Gandhi, A. R., Penazzato, M., Soeteman, D. I., & Revill, P. (2021). Optimizing infant HIV diagnosis with additional screening at immunization clinics in three sub-Saharan African settings: A cost-effectiveness analysis. Journal of the International AIDS.

[28].  Suryavanshi, N., Kadam, A., Gupte, N., et al. (2020). A mobile health-facilitated behavioural intervention for community health workers improves exclusive breastfeeding and early infant HIV diagnosis in India: A cluster randomized trial. Journal of the International AIDS Society, 23(7), e25555. https://doi.org/10.1002/jia2.25555.

[29].  Micek, M. A., Gimbel, S., Baptista, A. J., Karagianis, M., Coutinho, M., & Pfeiffer, J. (2014). Evaluation of routine health assessments and vaccination coverage at the 9-month mark in Mozambique. Journal of Pediatric Health Care, 28(6), 505-512. https://doi.org/10.1016/j.pedhc.2014.02.007.

[30].  Obonyo, B., & Mwachari, C. (2013). The impact of routine health assessments and vaccinations on infant health at 9 months in Kenya. East African Medical Journal, 90(5), 192-198. https://doi.org/10.4314/eamj.v90i5.3.

[31].  Banda, R., Habaalu, L., & Chiyesu, G. (2015). The significance of the 9-month health assessment and vaccination schedule for infant health in Zambia. African Health Sciences, 15(3), 856-862. https://doi.org/10.4314/ahs.v15i3.24.

[32].  Chiyesu, G., Habaalu, L., & Banda, R. (2016). The decline in appointment attendance among HEIs beyond the 9-month mark: Implications for tracking and healthcare delivery in Zambia. BMC Pediatrics, 16(1), 125. https://doi.org/10.1186/s12887-016-0662-8-Z.

[33].  Abimbola, J. M., Makanjuola, A. T., Ganiyu, S. A., et al. (2016). The pattern of utilization of ante-natal and delivery services in a semi-urban community of North-Central Nigeria. African Health Sciences, 16(4), 962–971. doi: 10.4314/ahs.v16i4.12.