Clinical and biological risk factors influencing infant HIV status in Uganda: case study of Kampala (Kisenyi Health Center IV)

Abstract

Transmission of HIV from mother to child (MTCT) contributes to 18% of the new HIV infections in Uganda. This research investigated how the clinical and biological risk factors were associated to the transmission of HIV from mothers to children in Uganda. Secondary data was collected from the patient charts of 200 HIV-positive mothers and their children who accessed services at Kisenyi Health Centre IV between 2017 and 2022. The study accounted for the fact that 22.5% of the newborns were HIV positive, leading to the selection of a probit regression model as the best- fitting model for the study variables. This model provided the lowest Akaike Information Criterion (AIC) value, with the child's HIV status as the primary outcome variable under examination. The study results revealed that the type of antiretroviral (ARV) regimen administered to the mother significantly influenced the HIV status of the child. The findings suggested that among the different types of antiretroviral (ARV) regimens, specifically, the regimen type called AZT/3TC/NVP (Zidovudine, Lamivudine, Nevirapine), was associated with a statistically significant increase in the odds of HIV positivity in children(OR= 5.12 ; p = 0.016). The odds of being HIV positive were 2.49 times higher for children whose mothers are receiving ABC/3TC/LPV regimen compared to the reference regimen TDF/3TC/EFV. The p-value (0.017) indicated statistical significance at 5% confidence interval. The research also found out that the HIV viral load of the mother plays a pivotal role as a biological determinant affecting the HIV status of the child. The findings demonstrated a statistically significant correlation (p=0.00) between the HIV viral load of the mother and the HIV status of the child, with an odds ratio (OR=5.06; p=0.00). This suggested that if the HIV viral load was above 1000 copies/mL, the likelihood of the child being HIV positive was 5 times higher, indicating a highly significant statistical outcome. These findings highlighted the importance of both clinical decision-making, such as the choice of type of ARV regimen, and the monitoring of the mother's HIV viral load (biological factor) during pregnancy to optimize the chances of delivering an HIV-negative child. The study also recommends that further research and interventions could build upon these findings to improve the overall outcomes of HIV treatment in pediatric populations.