Coverage of Early Infant Diagnosis of HIV infection and its determinants among HIV exposed children in Njombe Region, Tanzania

Background: Early Infant Diagnosis (EID) of HIV infection remains a public health concern. The World Health Organization recommends Polymerase chain reaction (PCR) HIV testing within 6 weeks after birth. This is to determine early initiation of antiretroviral therapy to prevent rapid disease progression and death in infected infants. Despite of many efforts, EID coverage is still low in Sub-Saharan Africa due to individual factors. This study aimed to investigate determinants of EID coverage among HIV exposed children in Njombe region, Tanzania.
Methods: A cross-sectional study was conducted in July 2021 among HIV exposed children aged 0-18 months and their biological mother attending reproductive and child health clinics in two districts of Njombe region of Tanzania. Swahili translated questionnaires were used to collect demographics, reproductive characteristics, HIV information, HIV related stigma, HIV disclosure and partner social support after obtaining consent. Multivariable logistic regression was used to determine factors associated with coverage of EID.
Results: A total of 400 HIV exposed children and their biological mothers were enrolled in this study. Median age of the mothers was 30 years (Interquartile Range, IQR 26-34) and majority had informal and primary education 307 (76.8%).  Median age of the children was 10 months (IQR 7-14) and most of them were females 226 (56.2%). The proportion of children who received EID within 4 to 6 weeks was 85%. Living in rural areas was associated with lower odds of testing (AOR = 0.37, 95% CI: 0.20-0.68).  Parents who reported higher level of HIV-related stigma and discrimination had a higher odd of testing (AOR = 2.96, 95% CI: 1.56-5.60).
Conclusion and Recommendation: This study found an improvement of EID coverage in Njombe region which might have resulted from Health system improvements in urban areas. More efforts in equipping NAT technology in rural health facilities and addressing individual factors need to be considered to improve EID coverage to national target. The region had successes toward addressing negative impact of HIV Stigma which is no longer barrier toward HIV testing. Multiple level HIV stigma reduction interventions should be directed toward Stigma rather than its outcomes.