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Background Determination of the human immunodeficiency virus (HIV) exposure status in infants and young children is required to guarantee timely diagnosis and access to appropriate care. HIV prevalence among Mozambican women aged 15-49 years is 15%, and vertical transmission rate is still high. The study investigated HIV exposure in children aged less than 2 years in Mozambique and the factors associated with unknown HIV exposure and with HIV exposure status in this population. Methods This was a cross-sectional analytical study using data from the 2015 Survey of Indicators on Immunization, Malaria and HIV/AIDS in Mozambique. A total of 2141 mothers (15-49 years) with children aged less than 2 years were interviewed. The dependent variables were “known HIV exposure status in a child” and “HIV-exposed child,” and the explanatory variables were mother’s social, demographic, economic, and reproductive health characteristics. We used binary and logistic regression, adjusted for complex sampling, to determine the association between variables. Results HIV exposure status was unknown in 27% of children (95% CI, 25.1-28.9). Mothers residing in the North (AOR, 4.41; 95% CI, 2.18-8.91), in rural area (AOR, 2.44; 95% CI, 1.33-4.35), with no education (AOR, 2.72; 95% CI, 1.38-5.36), and not having utilized any health services in the last pregnancy (AOR, 1.9; 95% CI, 1.42-2.55) were more likely to have a child with unknown HIV exposure status. Six percent of children were HIV-exposed (95% CI, 5-7). Children were less likely to be HIV-exposed if the head of the household was a male (AOR, 0.26; 95% CI, 0.08-0.86), if the mother was residing in the North (AOR, 0.41; 95% CI, 0.26-0.66) and did not utilize any health services in her last pregnancy (AOR, 0.52; 95% CI, 0.32-0.83). Conclusion The high proportion of children with unknown HIV exposure status and the associated socioeconomic factors suggests that HIV retesting of eligible women throughout breastfeeding should be intensified and identifies the urgent need to reach women without prior access to health care using a multisectoral approach.
This was a cross-sectional analytical study that used data collected during the 2015 Survey of Indicators on Immunization, Malaria and HIV/AIDS in Mozambique (IMASIDA) [3]. The primary aim of the survey was to estimate the following: HIV prevalence in the adult population, malaria prevalence, and immunization coverage in children aged less than 5 years in Mozambique. Besides the standard “household questionnaire,” the survey included a “woman and child health questionnaire” for women of childbearing age, focusing on malaria, immunization, maternal and child health, and HIV. The survey used a standardized questionnaire designed by the Demographic and Health Surveys (DHS) program, which is available for free download [13]. The questionnaire captured HIV indicators in women and children, which included HIV testing of women at the ANCs, at delivery, and during the postnatal period, the HIV test result at each of the previous contacts with the health services, and HIV testing offered to the child. Standard questions regarding mother and child health, including utilization of healthcare services, medicines taken, and infant’s feeding and immunization practices, were also asked. The survey was conducted between June 2015 and September 2015 using a systematic, multistage, stratified, and proportionate-to-size sampling [3]. The overall survey was designed to obtain the HIV prevalence estimates with 95% confidence intervals (CIs), an error margin of 5%, and a power of 80% and to ensure the representation of rural and urban areas and provincial levels. In the survey, a total of 8204 women were eligible for the interview, 7749 women consented for the same and 6946 women of childbearing age (15–49 years) were interviewed using the “woman and child health questionnaire” [3]. For the purpose of our analysis, we restricted the database to 2141 women aged between 15–49 years with at least one child aged less than 2 years on the day of the interview. Weights were computed by the DHS program [14] and provided as variable in the accessed database, allowing to adjust our analysis for unequal selection probabilities. The DHS program, funded by the US Agency for International Development (USAID), routinely conducts nationally representative surveys, including AIDS Indicator Survey, worldwide and generally in low- and middle-income countries. An HIV-exposed infant/child is an infant/child born to an HIV-positive mother or an infant who has been breastfed or is currently breastfed by an HIV-positive mother and whose definitive diagnosis has not yet been established up to the day of the interview [15]. The analysis considered the following two dependent variables: (1) “known HIV exposure status in a child,” coded as “1” in cases where the “child is known to have been HIV-exposed” or is “known to not have been HIV-exposed” and “0” if HIV exposure could not be ruled out, in cases of “unknown HIV exposure status in a child” and (2) “HIV-exposed status in a child,” coded as “1” if the child is “exposed to HIV,” coded as “0” if a child is “not exposed to HIV,” and coded as “8” in cases of “unknown HIV exposure status.” The variable “HIV-exposed status in a child” was computed by the DHS program and provided in the accessed database. Studies evaluating the determinants of access to and utilization of HIV prevention and care services constituted the basis for defining the key independent variables [16–20]. Besides the woman’s demographic characteristic, educational attainment, employment, religion, area and region of residence, socioeconomic status, and amenities of the households, the independent variables included the variables of health service utilization. Health service utilization was defined as the “use of antenatal care services, maternity, and postnatal care services.” Wealth index was provided as computed by the DHS program [14], which used a factor analysis for household amenities such as television, radio, refrigerator, bicycle, motorcycle, computer, water supply, sanitation, and cooking fuel [14]. Using transformations, we computed the following nominal independent variables: “media utilization” was defined as owing a television (TV) or a radio and watching TV or listening to the radio at least once a week, “mean of transport” was defined as owing a bicycle, or a motor bike or a car, and “immunization status of the child” according to the age-adjusted up-to-date vaccination for diphtheria-tetanus-pertussis (DPT) and measles. We used DPT1 (DPT dose 1), DPT2 (DPT dose 2), DPT3 (DPT dose 3), and Measles1 as the representative vaccines (“tracers”) considering that the other vaccines (rotavirus, HepB, Hib, polio, pneumococcal conjugate vaccine 10) are simultaneously administered with the tracer vaccines. Immunization was defined as up-to-date if the child had DPT1 by 2 months; DPT1 and DPT2 by 3 months; DPT1, DPT2, and DPT3 by 4 months, and DPT1, DPT2, DPT3, and measles by 24 months. If any of these age-adjusted vaccines were not reported, the immunization status of the child was considered “not up-to-date.” “Mother’s participation in family decisions” was obtained based on the answers to the questions on who decides on (1) household financial management, (2) healthcare utilization, (3) household purchases and expenses, and (4) visits to and from relatives. Participating in the decision-making was coded “1” if the mother decided alone or with other members on all of the described aspects and “0” if she reported no participation in one or more of the described aspects. First, the results of the descriptive analysis were expressed as absolute and relative frequencies with respective 95% CIs. Second, analyses were performed to identify the factors associated with “known HIV exposure status in a child” and “HIV-exposed status in a child” against the explanatory variables by bivariate association assessed by p, odds ratio (OR), and 95% CI. Third, binary logistic regression was used to estimate the adjusted OR (AOR) and 95% CI of being a child with unknown HIV exposure status and of being an HIV-exposed child against the socioeconomic, demographic, and health service utilization covariates. The association analysis was weighted and adjusted for complex sampling using the statistical package International Business Machines Corporation Statistical Package for the Social Sciences Statistics for Windows version 24.0 [21]. The 2015 IMASIDA Survey was approved by the Mozambican National Bioethics Committee (IRB00002657, reference 262/CNBS/2014) and the Ministry of Health. The participation was voluntary through a signed informed consent administered by a trained interviewer. For illiterate participants, the informed consent process was witnessed by a literate person chosen by the participant. For participants aged 15–17 years, signed informed consent was obtained from the legal guardian and assent from the participant. For this secondary data analysis, authorization for the use of database has been granted by the DHS program [22], the database was de-identified, and no informed consent was required from the participants. The database is publicly available through an application process to the DHS program site.
