Title

24-month incidence of hiv infection, loss to follow-up and mortality among exposed infants at referral hospitals in Uganda

Presenter

Maureen Kwikiriza

Authors

M. Kwikiriza¹, H. Alima¹, P. Elyanu², G. Tugume¹

Institutions

¹University Research Co LLC, Kampala, Uganda, ²University of Texas Health Sciences Center at Houston, School of Public Health, Texas, United States

Background: Uganda has implemented Option B+ since 2012, but there is limited data on 24-months outcomes of HIV exposed infants. We examined the 24-month cumulative incidence of HIV-Infection, loss to follow-up and death among HIV exposed infants at regional referral hospitals in Uganda. We also determined the factors associated with mother to child HIV transmission (MTCT).
Methods: We respectively reviewed clinical charts of HIV exposed infants (HEI) recruited in care between October 2012 and September 2013 at 11 regional referral hospitals in Uganda. The 24-month cumulative incidence of HIV, LTFU, and death was calculated using competing risks analysis, and predictors of MTCT determined using sub-distributional hazard regression analysis.
Results: .Of 2959 HEI, 83 (2.8%) were excluded for missing date of birth and 2776 were included in the analysis. Of these 2776, the median age at 1^st HIV test was 7 weeks [interquartile range: 6.4-12]. The 24-month cumulative of HIV infection, LTFU and death was 7.5% (95%CI: 6.6%, 8.5%), 31.7% (95%CI: 30%, 33.5%) and 0.9% (95%CI: 0.6%, 1.4%) respectively. The factors associated with MTCT were: mother or infant not receiving ARV''s for PMTCT Subdistributional Hazard ratio (sHR) 2.2(95% CI: 1.5, 3.2) and sHR 1.7(95%CI: 1.1, 2.6) respectively; Testing at age 2-6 month [sHR 2.1(95%CI: 1.3, 3.4)] or age >7month [sHR 2.8(95%CI: 1.5, 5.1)] compared to testing 2 months of age. Other factors were mixed feeding, complementary feeding or no-longer breastfeeding at the time of first HIV test compared to those who were exclusively breastfed see table 1.
Conclusions: MTCT rate and loss to follow-up of HEI from care at regional referral hospitals in Uganda are high. Factors to prevent MTCT are maternal and infant ARV use, early care entry and testing, and exclusive breastfeeding. Loss to follow-up should be addressed.

Predictors*	Total	% infected	Univariable analysis Crude SHR (95%CI) P-Value	Multivariable analysis aSHR (95% CI) p-Value
Mother ARV''s for PMTCTa Yes No	2207 246	5 24	1 5.1 (3.8, 7.1) <0.001	1 2.2(1.5,3.2) <0.001
Infant ARV''s for PMTCTb Yes No	1813 571	3.9 18.7	1 5 (3.7, 6.8) <0.001	1 1.7(1.1,2.6) 0.02
Infant feeding at testingc EBF Replacement feeding Mixed feeding Complementary feeding No longer BF	2198 82 86 276 86	3.8 11 17.4 24.3 24.4	1 3.1(1.6,6.2) 5.0(2.9,8.7) 6.7(4.9,9.2) 6.6(4.2,10.4) <0.001	1 1.9(0.9,4.1) 0.11 2.2(1.1,4.3) 0.022 2.1(1.2,3.8) 0.015 2.3(1.2,4.3) 0.008
Age (months) at 1st HIV test <2 2-6 >7	1699 731 346	2.8 9 26.3	1 3.3 (2.3,4.9) 9.7(6.9,13.8) <0.001	1 2.1(1.3,3.4) 0.003 2.8(1.5,5.1) 0.001
Place of deliveryd Health facility Home/TBA	2009 371	5.9 15	1 2.7(1.9,3.7) 0.05
Age of Mom (years)e <20 20-24 25 and above	45 289 1558	13.3 8 5.7	2.5 (1.1,5.7) 1.4 (0.9,2.2) 1
Entry pointf YCC ANC Maternity/postnatal ward Pead/nutrition OPD ART clinic Another health facility	651 396 677 81 171 354 134	4 4 2.36 56.8 14.8 7.34 11.2	1 1.0(0.5,1.9) 0.6(0.3, 1.1) 17.6(11,28.3) 4.1(2.4,7.0) 1.8(1.1,3.1) 2.9(1.5,5.5) <0.001	*adjusted for health facility a 323 missing values b392 missing values c48 missing values d396 missing values e884missing values f312 missing values SHR- subdistribution hazard ratio

[Factors associated with mother to child HIV transmission at 11 RRH, Uganda (N=2776)]