Background: Infant retention through the latter stages of the prevention of mother-to-child transmission (PMTCT) cascade is critical for preventing new paediatric HIV infections and reducing mortality through antiretroviral therapy (ART) initiation for infants testing positive. However, uptake of early infant diagnosis (EID) is low: only 43% of exposed infants enrolled in follow-up before 2 months in Malawi and national data from South Africa show, only 35% of mothers intended to access EID services.
Methods: We conducted in-depth interviews with 19 women who initiated ART for PMTCT under Option B+ in South Africa to understand their experiences with EID. Interviews were recorded, transcribed, and translated. Analysis followed a thematic approach: a coding framework was developed iteratively, and emerging themes were identified.
Results: Key themes included barriers and facilitating factors to undergoing EID, and consequences for care engagement. Most mothers followed counsellors'' advice on testing their infants, with some undergoing EID multiple times, fearing transmission through breastfeeding.
Furthermore, although most mothers were scared by the prospect of testing their infants, they were motivated by the desire to know their infant''s status and learn what to do if the child tested positive. Barriers to EID were previous positive results for infants from earlier pregnancies, and the mother''s own acceptance of her status.
Mothers expressed relief from learning that their infant was negative. However, a negative result could also lead to disengagement from care where mothers took the result as proof that they themselves were in fact negative.
Positive results caused stress and anxiety, but mothers generally felt they should accept this result and get the infant on ART in order to keep them healthy. For some participants, a positive result for their infant led to their own disengagement from care, due to the double burden of their own treatment visits and their infants, with these mothers opting to attend their infant''s visit over their own.
Conclusions: Women''s experiences and expectations regarding EID influenced their own engagement in HIV care. Retention in care for Option B+ mothers may be improved with additional counselling around the time of EID, and joint ART clinic visits for positive mother-baby pairs.

A conceptual framework of the relationship between early infant diagnosis and mother and infant engagement in care
[A conceptual framework of the relationship between early infant diagnosis and mother and infant engagement in care]

Age19-24 years25-29 years30-34 years35-39 years40+ years
Self-reported treatment status
In care33310
Not in care22110
[Demographic and treatment characteristics of participants]