Early Infant Diagnosis of Hiv In the Eastern Region of Ghana: Stakeholders’ Knowledge and Implementation Challenges

Abstract

Background Infants who acquire HIV infection vertically experience rapid deterioration, usually leading to death. Early initiation of ART can reverse this trend. The WHO therefore recommends virological HIV testing in all exposed infants by six weeks, and if positive, promptly initiate ART. Despite the implementation of early infant testing in Ghana, coverage among eligible infants remains low and infants are tested late, resulting in erosion of possible benefits. Study Objectives This study was therefore designed to assess the performance of EID, assess service providers’ and caregivers’ knowledge about EID, and document the challenges these stakeholders face in the implementation of EID in the Eastern region of Ghana. Methods The study was a mixed methods research conducted at the Eastern Regional Hospital and St. Martin de Porres Hospital. A desk review of EID tests done in the facilities was conducted to determine the proportion of eligible infants who tested, age at testing and turn-around times for results delivery between 2013 and 2015. In-depth interviews were conducted with the stakeholders to assess their knowledge and find out the challenges they faced in the provision of EID services. Results Only 27.6% of eligible infants were tested for EID. Median age of infants at the time of testing was 9.4 weeks and were over 7 months old before the results reached their EID sites. HIV positive infants would, therefore, have deteriorated before life-saving ART could be initiated. Service providers had adequate knowledge about EID but only laboratory technicians collected and processed DBS samples. Caregivers showed mixed levels of knowledge about EID. Provider related barriers identified were delays in sample transportation, sample testing and result delivery; frequent breakdown of equipment and shortage of supplies; and high workload for few, poorly motivated staff. Caregiver related challenges were incorrect phone numbers and addresses; financial constraints; non-disclosure and denial of HIV status.