Predictors of HIV Testing among HIV-Exposed Children in Ahafo, Western & Western North Regions of Ghana

Abstract

Background: HIV/AIDS remains a significant global health challenge, particularly in sub-Saharan Africa, where early infant diagnosis (EID) plays a critical role in reducing HIV-related infant mortality. This study investigates factors influencing the completion of EID among HIV-exposed infants. It also determines the completion proportions of EID testing, the temporal intervals between scheduled tests, and the proportion of HIV infection among HIV-exposed children in the Ahafo, Western, and Western North Regions of Ghana. Methods: A retrospective cross-sectional study design was employed, focusing on HIV-exposed infants and their paired mothers. Exposed infants testing data were extracted from Early Infant Diagnosis (EID) registers across Antiretroviral Therapy (ART) sites in the Ahafo, Western, and Western North Regions of Ghana. The dataset comprising 1,543 HIV-exposed infants was used to determine test completion rates, infection rates, and temporal intervals related to HIV testing among exposed children, while a sample of 249 paired mothers was drawn from this cohort and interviewed to provide complementary qualitative insights. A Multivariable logistic regression analysis was conducted at a 95% confidence level to determine the factors influencing EID test completion. Results: The study found that 18.5% of HIV-exposed infants completed all recommended EID tests, with significant regional disparities observed. The Western Region had the highest completion rate at 24.0%, while Western North recorded the lowest at 11.4%. The overall HIV infection rate among the infants was 2.3%. Delays in testing were notable, with the first test completed at a mean age of 10.71 weeks, exceeding the recommended 6-week timeframe. The results revealed that maternal factors significantly influenced the completion of scheduled EID testing, with mothers who were alive being 27 times more likely to have their infants complete testing (OR = 26.53, 95% CI: [2.61, 269.72], P = 0.006). Infant-related factors such as higher birth weight increased the odds of EID test completion (AOR = 2.169, 95% CI: [1.118, 4.209], P = 0.022), while infants receiving AZT-only or NVP-only prophylaxis had reduced odds compared to those on AZT + NVP (AOR = 0.358, P = 0.014; AOR = 0.152, P < 0.001, respectively). However, health system factors examined were not associated with EID test completion. Conclusion: A critical focus should be placed on orphaned HIV-exposed infants by implementing a policy framework that systematically ensures their follow-up and continuous access to health care services, thereby addressing their clinical care and HIV testing needs. Addressing these factors is crucial for improving testing rates among HIV-exposed infants, thereby contributing to Ghana's efforts to reduce mother-to-child transmission and improve overall child health outcomes