HIV Profile of Neonatal Centre of Excellence Unit Admissions at the University Teaching Hospital-Children Division, Lusaka, Zambia After 2 Decades of PMTCT: Retrospective Pilot Study

Objectives
The aim of this study was to examine the prevalence of congenital HIV infection at the Neonatal Centre of Excellence Unit (NCOE), Children Division of the University Teaching Hospitals (UTH), and to analyze the characteristics of neonates who tested positive and negative for HIV PCR.
Subject and methods
This study is a pilot investigation that analyzed retrospective cross-sectional data from 757 mother-neonate pairs. The data was collected over a 12-month period from the ward register and file records at the NCOE Unit, UTH - Children's Division in Lusaka, Zambia. The prevalence and characteristics of HIV among hospitalized neonates were assessed using percentages, Chi-square tests, ANOVA, and binary logistic regression model. The results were reported in terms of p-values, odds ratios, and 95% confidence intervals.
Results
In 2024, the annual rates of HIV and Syphilis among all neonatal admissions at NCOE were recorded at 4.1% and 5.9%, respectively. The HIV status for 52 neonates (6.9%) was not available. The median age of the neonates at the time of admission was 14 days, with an interquartile range (IQR) of 9 to 21 days. The maternal HIV positivity rate was 11.9%, while the paternal rate was 7.3%. Notably, a greater number and percentage of fathers had unknown HIV status (103, 13.6%) compared to mothers (20, 2.6%). The rate of HIV exposure was 48.3%. A total of twenty-nine mothers, accounting for 3.8%, did not attend the antenatal clinic during their pregnancy.
Overall, the incidence of teenage pregnancies was 4.9%, and 47 mothers, or 6.2%, delivered outside of healthcare facilities. The rate of cesarean sections was 20.6%, and 57.3% mothers experienced delays in starting breastfeeding. Furthermore, 82.2% of neonates were referred from other healthcare facilities, and 73.6% showed indicators of growth faltering. A significant number of neonates presented at admission with abnormal body temperatures (60.1%), heart rates (66.8%), and respiratory rates (83%).
The characteristics of neonates diagnosed with HIV were comparable in all examined aspects to those without HIV. The sole distinctions observed were that mothers of HIV-positive neonates were, on average, significantly older (31.1 years, with a standard deviation of 5.40 years, representing a 3.37-year increase, and a 95% CI of 1.19 to 5.55, with a p-value of 0.003). Furthermore, these HIV-positive neonates had a greater propensity to be born to discordant couples (15.4% vs 1.5%; OR=11.72. 95% CI 3.35, 40.99; p=0.001); mothers with moderate parity (OR = 2.51; 95% CI: 1.05 to 5.88; p=0.032), to be born prematurely (OR=5.83; 95% CI: 1.15 to 29.58; p=0.047), and exhibited significantly impaired postnatal growth (OR= 3.02; 95% CI: 1.26 to 7.24; p=0.010) when contrasted with HIV-negative neonates. Notably, the impairment of postnatal growth manifested earlier than anticipated, with a substantial rate of 74.1% observed among the HIV-positive infants.
Neonates whose record of HIV status was missing presented with distinct characteristics compared to those with a known HIV status. Specifically, neonates with unknown HIV status were more frequently born to parents who were either HIV positive or whose HIV status was also unknown, as opposed to parents who were HIV negative (p<0.001). Furthermore, these neonates were less likely to have received antenatal care (p<0.001; OR=4.83, 95% CI 1.96-11.91). They also exhibited delayed initiation of breastfeeding, demonstrated impaired growth, and presented with relatively elevated random blood glucose levels and irregular body temperature at the time of admission.
The prevalence of discordant couples was observed to be 20.9% (19 out of 91couples). This rate was notably higher among infants whose HIV status was unknown, at 27.3% (6 out of 22), compared to 20% (10 out of 50) for infants with known HIV status, a statistically significant difference (p<0.001) with an odds ratio of 9.07 (95% confidence interval: 3.16 to 26.00). Among all the 19 identified discordant couples, 18 mothers tested positive for HIV, while only 1 father tested positive.
Conclusion
The significant number of mothers lacking antenatal care in this study is a cause for concern and poses a risk to the advancement of the Prevention of Mother-to-Child Transmission (PMTCT) program within the nation. Intensified antenatal care initiatives, encompassing early HIV screening for expectant mothers and their partners, are imperative to enable the timely initiation of Antiretroviral Therapy (ART) and PMTCT services. Particular vigilance is warranted for neonates presenting with an unknown HIV status in healthcare facilities within resource-limited environments. Such infants, especially those born to mothers aged >25years, with inadequate or absent antenatal care, those with moderate parity, premature births, delayed breastfeeding initiation, faltering growth, and abnormal vital signs, should be suspected of HIV positivity and undergo early infant testing to further mitigate infant morbidity and mortality. Regular assessment of these infants' feeding, health, and growth shortly after birth is crucial, either through home visits or postnatal clinic appointments. Targeted counseling for mothers (and partners) with unknown HIV status, HIV positive infants, infants with unknown HIV status, women aged >25 years, belonging to discordant couples; and public education are essential for reducing HIV incidence and improving infant health outcomes within the community.

Congenital HIV, PMTCT, Discordant couples

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