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Barriers to early infant diagnosis of HIV in the Wa Municipality and Lawra District of Upper West Region, Ghana

Robert D. Nuoh
Kofi M. Nyarko
Charles L. Noora
Adolphina Addo Lartey
Priscillia Nortey
Culbert Nuolabong
Margaret Lartey
Ernest Kenu


Objective: We identified socio-demographic, health system and psycho-social barriers to Early Infant Diagnosis (EID) of HIV in the Upper West Region of Ghana.
Design: An unmatched case control study of 96 cases and 96 controls was conducted in the ART centers in Lawra district and Wa Municipality between December 2014 and April 2015.
Setting: A public health facility
Participants: We defined a case as an HIV positive mother with an exposed infant who received EID service between January 2011 and December 2014. A control was defined as HIV Positive Mother with an exposed infant who did not receive EID services between January 2011 and December 2014.
Main outcome: EID by dry blood spot Deoxyribonucleic acid Polymerase chain reaction.
Results: A total of 192 mother-infant pairs were assessed. The mean age of infants at testing for cases was 17.3±14.9 weeks. Mother-to-child-transmission-rate was 2.3%. Factors associated with EID testing included: mother being formally
employed (cOR=2.0: 95%CI:1.1-3.8), maternal formal education (cOR=2.0, 95%CI: 1.1-3.6) and maternal independent source of income (cOR 2.2, 95%CI 1.2-4.1). After adjusting for confounders, maternal independent incomebsource was associated with EID testing (aOR 2.2, 95%CI 1.2-4.1). Median turn-around time of EID result was 11 weeks (IQR 4-27weeks).
Conclusion: Women need to be empowered to gain an independent source of income. This can help maximize the benefits of e-MTCT and increase EID in the Upper West Region of Ghana.
Keywords: Barriers; HIV; early infant diagnosis; DNA-PCR; Ghana
Funding: This work was funded by the authors