{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T04:12:09Z","timestamp":1749615129488,"version":"3.41.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\nBackground<\/jats:title>\nEarly infant diagnosis (EID) facilitates early initiation into HIV care for identified HIV-positive infants. According to the Uganda Ministry of Health, EID testing algorithm, testing for infants exposed to HIV (IEH) should occur at <6 weeks, 9 and 18 months of age, and 6 weeks after stopping breastfeeding. Uganda has faced challenges with loss to follow-up (LTFU) of IEH for EID. We assessed complete testing coverage (CTC) to the EID algorithm for IEH and associated factors.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWe analyzed data from the \u2018Impact of the National Program for the Prevention of Vertical Transmission (PVT) of HIV in Uganda (2017\u22122019)\u2019 study. Mothers living with HIV whose infants tested HIV-negative at 4\u201312 weeks were enrolled in a prospective cohort (2017\u2009\u2212\u20092018) and followed until the IEH tested positive, died, was LTFU, or reached 18 months of age. We computed the proportion of IEH tested according to the EID algorithm among surviving infants. CTC was defined as undergoing HIV tests at three designated time points (excluding the 6 weeks after breastfeeding cessation) if HIV negative. IEH who were diagnosed with HIV but were tested at all recommended tests until that point were also considered to have CTC. We evaluated factors associated with CTC using modified Poisson regression.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nAmong 1,804 IEH, 912 (51%) were male. Of the 1,804 IEH at baseline, 27 (1%) died. Among the 1,777 IEH included in the primary outcome analysis, 1,282 (72%) completed the study and 941 (53%) infants had CTC according to the EID testing algorithm including 40 (2%) who tested HIV-positive. Perceived discrimination due to HIV status [RR\u2009=\u20090.77, 95%CI (0.65\u20130.92)], having fewer pregnancies [RR\u2009=\u20090.97, 95%CI (0.68\u20130.99)], and reporting sexual violence [RR\u2009=\u20090.82, 95%CI (0.73\u20130.93)] by the mother of IEH were associated with non-CTC.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nAbout half of IEH were tested at the recommended time points. Interventions to address stigma and sexual violence for mothers may improve CTC for the EID algorithm. Investigations are needed to explore associations between sexual violence, parity, and CTC for the EID algorithm.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324338","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T17:48:25Z","timestamp":1749577705000},"page":"e0324338","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Complete testing coverage for the early infant diagnosis algorithm and associated factors among infants exposed to HIV, Uganda, 2017\u20132019"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7191-4318","authenticated-orcid":true,"given":"Rebecca","family":"Akunzirwe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie R.","family":"Harris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter Chris","family":"Kawungezi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercy W.","family":"Wanyana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Lutalo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phoebe Monalisa","family":"Namukanja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustina","family":"Delaney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-9521","authenticated-orcid":true,"given":"Richard","family":"Migisha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Nyamugisa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doreen","family":"Ondo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Kasibante","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Kadobera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lilian","family":"Bulage","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane Frances","family":"Zalwango","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex Riolexus","family":"Ario","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda Kisaakye","family":"Nabitaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"pone.0324338.ref001","author":"World Health Organisation","year":"2024"},{"key":"pone.0324338.ref002","author":"UNAIDS","year":"2023"},{"key":"pone.0324338.ref003","author":"Uganda AIDS Commission","year":"2023"},{"key":"pone.0324338.ref004","author":"UNAIDS","year":"2023"},{"issue":"9","key":"pone.0324338.ref005","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1089\/apc.2006.0167","article-title":"Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort","volume":"21","author":"MJ Mugavero","year":"2007","journal-title":"AIDS Patient Care STDS"},{"issue":"13","key":"pone.0324338.ref006","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1097\/QAD.0b013e3282c3a9e4","article-title":"Risk factors for early mortality in children on adult fixed-dose combination antiretroviral treatment in a central hospital in Malawi","volume":"21","author":"C-N Bong","year":"2007","journal-title":"AIDS"},{"issue":"1","key":"pone.0324338.ref007","first-page":"5","article-title":"Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya liyu zone, Amhara region, Ethiopia: a retrospective cohort study. BMC","volume":"22","author":"SA Weldemariam","year":"2022","journal-title":"Pediatrics"},{"key":"pone.0324338.ref008","author":"Ministry of Health","year":"2020"},{"issue":"2","key":"pone.0324338.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0246546","article-title":"Uganda\u2019s \u201cEID Systems Strengthening\u201d model produces significant gains in testing, linkage, and retention of HIV-exposed and infected infants: an impact evaluation","volume":"16","author":"C Kiyaga","year":"2021","journal-title":"PLoS One"},{"key":"pone.0324338.ref010","author":"Ministry of Health","year":"2018"},{"issue":"2","key":"pone.0324338.ref011","doi-asserted-by":"crossref","first-page":"030","DOI":"10.17352\/2455-3786.000011","article-title":"Adherence to early infant diagnosis testing algorithm, a challenge to early infant diagnosis program in resource limited settings of Uganda","volume":"2","author":"C Kiyaga","year":"2015","journal-title":"J HIV Clin Sci Res"},{"key":"pone.0324338.ref012","article-title":"Scale-up of early infant HIV diagnosis and improving access to pediatric HIV care in global plan countries: past and future perspectives","author":"S Essajee","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0324338.ref013","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1186\/s12913-015-1213-5","article-title":"Use of peers, community lay persons and Village Health Team (VHT) members improves six-week postnatal clinic (PNC) follow-up and Early Infant HIV Diagnosis (EID) in urban and rural health units in Uganda: a one-year implementation study","volume":"15","author":"Z Namukwaya","year":"2015","journal-title":"BMC Health Serv Res"},{"issue":"11","key":"pone.0324338.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0078609","article-title":"Uganda\u2019s new national laboratory sample transport system: a successful model for improving access to diagnostic services for early infant HIV diagnosis and other programs","volume":"8","author":"C Kiyaga","year":"2013","journal-title":"PLoS One"},{"key":"pone.0324338.ref015","author":"PEPFAR","year":"2021"},{"key":"pone.0324338.ref016","unstructured":"Ministry of Health. Evaluation of the adoption, implementation and effectiveness of PMTCT retention interventions in Uganda: 2015 \u2013 2020. 2022."},{"key":"pone.0324338.ref017","author":"Ministry of Health","year":"2020"},{"key":"pone.0324338.ref018","author":"Ministry of Health","year":"2022"},{"key":"pone.0324338.ref019","author":"STRIVE","year":"2018"},{"key":"pone.0324338.ref020","volume-title":"The physicians\u2019 guide to helping patients with alcohol problems","author":"Abuse NIoA, Alcoholism","year":"1995"},{"issue":"8","key":"pone.0324338.ref021","article-title":"What\u2019s the risk: differentiating risk ratios, odds ratios, and hazard ratios?","volume":"12","author":"A George","year":"2020","journal-title":"Cureus"},{"issue":"7","key":"pone.0324338.ref022","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/S1047-2797(01)00278-2","article-title":"What\u2019s the relative risk? A method to directly estimate risk ratios in cohort studies of common outcomes","volume":"12","author":"AS Robbins","year":"2002","journal-title":"Ann Epidemiol"},{"issue":"2","key":"pone.0324338.ref023","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000334180","article-title":"How to deal with measures of association: a short guide for the clinician","volume":"33","author":"MJ Knol","year":"2012","journal-title":"Cerebrovasc Dis"},{"issue":"1","key":"pone.0324338.ref024","doi-asserted-by":"crossref","first-page":"5638","DOI":"10.1038\/s41598-023-32056-y","article-title":"Access, timeliness and retention for HIV testing under early infant diagnosis (EID) program, India","volume":"13","author":"S Kamble","year":"2023","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0324338.ref025","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1186\/s12887-022-03656-w","article-title":"Loss to follow-up of HIV-exposed infants for confirmatory HIV test under Early Infant Diagnosis program in India: analysis of national-level data from reference laboratories","volume":"22","author":"N Gawde","year":"2022","journal-title":"BMC Pediatr"},{"issue":"3","key":"pone.0324338.ref026","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/QAI.0000000000002263","article-title":"Brief report: improving early infant diagnosis observations: estimates of timely HIV testing and mortality among HIV-exposed infants","volume":"83","author":"K Webb","year":"2020","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"pone.0324338.ref027","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s10461-010-9877-7","article-title":"Dynamics and constraints of early infant diagnosis of HIV infection in Rural Kenya","volume":"16","author":"AS Hassan","year":"2012","journal-title":"AIDS Behav"},{"issue":"8","key":"pone.0324338.ref028","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1007\/s10461-021-03204-0","article-title":"A pilot study to evaluate the impact of the HIV Infant Tracking System (HITSystem 2.0) on Priority Prevention of Mother-to-Child Transmission (PMTCT) outcomes","volume":"25","author":"S Finocchario-Kessler","year":"2021","journal-title":"AIDS Behav"},{"issue":"2","key":"pone.0324338.ref029","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/tmi.13014","article-title":"Interventions to significantly improve service uptake and retention of HIV-positive pregnant women and HIV-exposed infants along the prevention of mother-to-child transmission continuum of care: systematic review","volume":"23","author":"AC Vrazo","year":"2018","journal-title":"Trop Med Int Health"},{"issue":"1","key":"pone.0324338.ref030","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s12160-013-9576-5","article-title":"The dynamic relationship between social support and HIV-related stigma in rural Uganda","volume":"48","author":"S Takada","year":"2014","journal-title":"Ann Behav Med"},{"issue":"1","key":"pone.0324338.ref031","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s10461-016-1451-5","article-title":"How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes","volume":"21","author":"B Turan","year":"2017","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0324338.ref032","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1007\/s10461-016-1320-2","article-title":"Interpersonal mechanisms contributing to the association between HIV-related internalized stigma and medication adherence","volume":"21","author":"C Blake Helms","year":"2017","journal-title":"AIDS Behav"},{"issue":"10","key":"pone.0324338.ref033","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1111\/tmi.13473","article-title":"Association between HIV stigma and antiretroviral therapy adherence among adults living with HIV: baseline findings from the HPTN 071 (PopART) trial in Zambia and South Africa","volume":"25","author":"HS Jones","year":"2020","journal-title":"Trop Med Int 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Hatcher","year":"2014","journal-title":"J Int AIDS Soc"},{"key":"pone.0324338.ref037","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.socscimed.2016.02.011","article-title":"Intimate partner violence and HIV-positive women\u2019s non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia","volume":"153","author":"KM Hampanda","year":"2016","journal-title":"Soc Sci Med"},{"issue":"1","key":"pone.0324338.ref038","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/s12889-022-12619-w","article-title":"A systematic review of the effects of intimate partner violence on HIV-positive pregnant women in sub-Saharan Africa","volume":"22","author":"AM Yonga","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0324338.ref039","doi-asserted-by":"crossref","first-page":"100112","DOI":"10.1016\/j.ssmmh.2022.100112","article-title":"Intimate partner violence and HIV treatment adherence in urban 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