Facilitators and barriers to HIV testing for infants of caregivers who delivered at Entebbe Hospital, Wakiso District, Uganda

Abstract

Introduction: Despite overwhelming evidence about benefits of early initiation of antiretroviral treatment (ART) for HIV-exposed children in terms of reducing their morbidity and mortality, there are children in Uganda and globally who still do not access treatment. Early infant diagnosis (EID) of HIV infection offers an opportunity for identifying, follow up and testing for HIV-exposed infants. In Uganda, despite the availability of EID of HIV infection for infants, many are left undiagnosed or diagnosed when it is too late, resulting in high HIV-related child mortality. The aim of this research therefore was to explore the facilitators and barriers to EID of HIV for infants of mothers who delivered at Entebbe hospital in Uganda and from this propose lessons for increasing EID uptake. Methodology: The study utilised a qualitative exploratory approach using in-depth interviews with mothers who brought back their children for early HIV testing and those who never returned their children for testing. Key informant interviews were conducted with health care providers and peer mothers. Interviews were recorded and transcribed verbatim. Data were analysed using the thematic content analysis approach to identify themes and patterns in the data. Results: Individual, health facility, community and economic factors were found to affect EID uptake. Individual factors include limited knowledge about: the timing for EID, the efficacy of PMTCT interventions and HIV treatment and the fact that asymptomatic children can be HIV-positive. Other caregiver factors include fear of finding out their children are HIV-positive, denial of HIV status, fear of disclosure and the resulting stigma and discrimination, caregiver religious and cultural beliefs. The negative attitudes of the health care workers, fear of breach of confidentiality, inadequate EID information from the health care workers, caregiver place of delivery and long waiting times were the health facility factors affecting EID. Conclusion: Early infant diagnosis is a critical gateway to prevention and care services for paediatric HIV. The results of this study suggest that factors at caregiver level are critical drivers that influence uptake of EID at Entebbe hospital, Uganda. Providing information to caregivers and promoting awareness about the benefits of testing infants early are the recommended strategies for increasing uptake.