{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T19:09:50Z","timestamp":1785870590943,"version":"3.56.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009914","name":"Makerere University","doi-asserted-by":"publisher","award":["MAK\/DVCFA\/113\/20)"],"award-info":[{"award-number":["MAK\/DVCFA\/113\/20)"]}],"id":[{"id":"10.13039\/501100009914","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Despite global efforts to eliminate mother-to-child-transmission of HIV (MTCT), many children continue to become infected. We determined the prevalence of HIV among children with severe acute malnutrition (SAM) and that of their mothers, at admission to Mwanamugimu Nutrition Unit, Mulago Hospital, Uganda. We also assessed child factors associated with HIV-infection, and explored factors leading to HIV-infection among a subset of the mother-child dyads that tested positive.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>We conducted a cross-sectional evaluation within the REDMOTHIV (Reduce mortality in HIV) clinical trial that investigated strategies to reduce mortality among HIV-infected and HIV-exposed children admitted with SAM at the Nutrition Unit. From June 2021 to December 2022, we consecutively tested children aged 1 month to 5 years with SAM for HIV, and the mothers who were available, using rapid antibody testing upon admission to the unit. HIV-antibody positive children under 18 months of age had a confirmatory HIV-DNA PCR test done. In-depth interviews (IDIs) were conducted with mothers of HIV positive dyads, to explore the individual, relationship, social and structural factors associated with MTCT, until data saturation. Quantitative data was analyzed using descriptive statistics and logistic regression in STATAv14, while a content thematic approach was used to analyze qualitative data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 797 children tested, 463(58.1%) were male and 630(79.1%) were \u226418months of age; 76 (9.5%) tested positive. Of 709 mothers, median (IQR) age 26 (22, 30) years, 188(26.5%) were HIV positive. Sixty six of the 188 mother\u2013infant pairs with HIV exposure tested positive for HIV, an MTCT rate of 35.1% (66\/188). Child age &gt;18 months was marginally associated with HIV-infection (crude OR = 1.87,95% CI: 1.11\u20133.12, p-value = 0.02; adjusted OR = 1.72, 95% CI: 0.96, 3.09, p-value = 0.068). The IDIs from 16 mothers revealed associated factors with HIV transmission at multiple levels. Individual level factors: inadequate information regarding prevention of MTCT(PMTCT), limited perception of HIV risk, and fear of antiretroviral drugs (ARVs). Relationship level factors: lack of family support and unfaithfulness (infidelity) among sexual partners. Health facility level factors: negative attitude of health workers and missed opportunities for HIV testing. Community level factors: poverty and health service disruptions due to the COVID-19 pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In this era of universal antiretroviral therapy for PMTCT, a 10% HIV prevalence among severely malnourished children is substantially high. To eliminate vertical HIV transmission, more efforts are needed to address challenges mothers living with HIV face intrinsically and within their families, communities and at health facilities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0301887","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T18:08:00Z","timestamp":1713290880000},"page":"e0301887","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["HIV prevalence among children admitted with severe acute malnutrition and associated factors with mother-to-child HIV transmission at Mulago Hospital, Uganda: A mixed methods study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7472-9054","authenticated-orcid":true,"given":"Victor","family":"Musiime","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Rujumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Kakooza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henriator","family":"Namisanvu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loice","family":"Atuhaire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erusa","family":"Naguti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Beinomugisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Kiggwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharafat","family":"Nkinzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Segawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Matsiko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Babirekere-Iriso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Musoke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,16]]},"reference":[{"key":"pone.0301887.ref001","article-title":"Consolidated 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AIDS Care"},{"issue":"36","key":"pone.0301887.ref031","doi-asserted-by":"crossref","first-page":"e30282","DOI":"10.1097\/MD.0000000000030282","article-title":"Effect of the COVID-19 pandemic restrictions on outcomes of HIV care among adults in Uganda.","volume":"101","author":"J Izudi","year":"2022","journal-title":"Medicine (Baltimore)."},{"issue":"1","key":"pone.0301887.ref032","article-title":"Factors associated with the risk of HIV infection among HIV-exposed infants in Malawi: 2013\u20132020","volume":"6","author":"WF Ng\u2019ambi","year":"2022","journal-title":"BMJ Paediatr Open"},{"issue":"2","key":"pone.0301887.ref033","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.2217\/fvl.11.119","article-title":"Host factors that influence mother-to-child transmission of HIV-1: genetics, coinfections, behavior and nutrition.","volume":"6","author":"SR Ellington","year":"2011","journal-title":"Future Virol."},{"key":"pone.0301887.ref034","doi-asserted-by":"crossref","article-title":"Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study.","author":"SI McCoy","DOI":"10.1201\/9781315365763-6"},{"issue":"10","key":"pone.0301887.ref035","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1097\/INF.0000000000001971","article-title":"Pneumonia in HIV-exposed and Infected Children and Association With Malnutrition.","volume":"37","author":"PY Iroh Tam","year":"2018","journal-title":"Pediatr Infect Dis J."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301887","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T18:08:14Z","timestamp":1713290894000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301887"}},"subtitle":[],"editor":[{"given":"Rornald Muhumuza","family":"Kananura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,16]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0301887","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,16]]}}}