Factors Influencing Use of Early Infant Diagnosis of Hiv Services within the Accra Metropolitan and Ledzokuku Krowor Municipal Area

Abstract

Introduction: It is estimated that over 90% of HIV infections in children is acquired through mother to child transmission (MTCT). Transmission can however be prevented if infected mothers have access to antiretroviral therapy (ART) during pregnancy, delivery and breast feeding. According to WHO, the absence of ART can increase MTCT rates by 15% to 45% however, transmission rates can reduce to below 5% with the availability of ART. It is therefore imperative that all infants born to HIV positive mothers are promptly diagnosed and initiated on ART if found to be reactive. Providing HIV infected infants with timely HIV interventions and treatment could increase their survival rate by 75%. Irrespective of the benefits obtained from early infant testing, the use of Early Infant Diagnosis (EID) of HIV services is unacceptably low in Sub-Saharan Africa, including Ghana. It is critical that the factors attributing to low coverage of EID services are immediately identified and addressed. Objective: The purpose of the study was to ascertain the knowledge of health workers and HIV positive mothers on EID services. It also sought to identify the health system factors that influenced delivery of EID services, the barriers to the use of EID services among HIV positive mothers and also their perceptions on the use of the service. Methods: The study was an exploratory qualitative research conducted at the Greater Accra Regional Hospital and the LEKMA Hospital. A criterion purposive sampling technique was utilised in selecting study participants. Fifty respondents comprising 20 health workers and 30 HIV positive mothers were engaged in in-depth interviews. Braun and Clarke’s stages of thematic analysis were employed in analysing data. Results: Both health workers and HIV positive mothers were adequately knowledgeable of EID of HIV services. Health system factors such as inadequate staff, transportation challenges, long turnaround time for the return of PCR results, inadequate and frequent breakdown of PCR machine were identified as inhibitors to EID service delivery. Availability of DBS cards, adoption of task shifting strategies and positive attitudes of health workers served as facilitators. Maternal factors such as denial of HIV status, lost to follow up in the EID process, dependency on significant others and consequences after disclosure of HIV status were factors that served as barriers to mother’s utilization of EID services for their exposed infants. Conclusion: The study concludes that maternal and health system factors influence the utilization of EID services. It is important that the identified hindering factors are urgently addressed to improve service use.