Determinants of HIV diagnosis in children aged 0-59 months in Tete

Abstract

Introduction Access to early childhood diagnosis (ECD) has improved significantly in recent years, but only 50% of all HIV-exposed children worldwide were tested by the second year of age in 2016 (WHO, 2017). Data on barriers to diagnosis and access to ART in children is limited, however, the main challenges are observed at multiple levels, at the level of the caregiver/patient, provider/institution and local policies implemented. Objective. Understand the determinants of HIV diagnosis in children aged 0-59 months in Tete province; Methodology. We conducted a cross-sectional, descriptive and quantitative study in 4 districts of Tete Province, namely Angonia, Changara, Tsangano and Chiuta as they have the lowest rates of pediatric ART. A questionnaire was administered to randomly selected caregivers of children aged 0-59 months and healthcare providers between September and October 2021. Results and Discussion: 843 caregivers and providers participated, of which 50.5% (421) were female and 49.5 (413) male, with an average age of 23.84 years, 47.2% (394) of these had primary school level, 35 5% (296) had secondary education and 16.9% (141) had no school education, of which 0.4% (3) were participants with higher education. Also 94.0% (784) of the participants were unemployed and only 3.6% (30) had some type of job and 1.0% (8) were students. After factorial and bivariate analysis, some factors showed a statistically significant relationship with an adequate diagnosis, these include access to a US (p<.000), situation of social disadvantage (p<.009), quality of filling out the child's card ( p<002). It was noted that not being in a situation of social disadvantage (95% CI OR 0.684 (0.493-0.949) P<0.023), easy access to health services (95% CI OR 0.454 (0.333-0.62) P<0.000) and Well Completed Card (95% CI OR 2.408 (1.767-3.282) P<0.000) increases diagnostic opportunities in children aged 0-59 months. Conclusion: However, for a timely, correct and updated diagnosis, determinants such as easy access to a US, social disadvantage and filling out the child's card are crucial. To scale the first 95% of the WHO 95-95-95 strategy in the pediatric population, interventions in these described axes and others must be imperative, depending on each context.