Knowledge and Perspectives on Barriers to Pediatric HIV Testing of HIV-Positive Mothers and Health Workers in Bouaké, Côte d'Ivoire

Mother to child transmission (MTCT) accounts for over 90% of childhood HIV infection. Although MTCT programs have expanded access to HIV testing for pregnant women, follow-up of exposed children after birth continues to be a challenge. The international community recommends diagnosing HIV-exposed children as young as six weeks of age for timely interventions. However, in 2007, only 8% of infants born to HIV-positive mothers get tested in the first two months of life . In 2009, PCR testing using dried blot spot (DBS) became available in Bouaké, Côte d'Ivoire, a city greatly affected by a five-year socio-political crisis that ended in 2007. Health Alliance International, which works with the Ministry of Health scale up HIV services in Bouaké, identified an issue of low levels of testing among HIV-exposed infants. Using qualitative methods, 34 participants were interviewed: 22 HIV-positive women who delivered within two years, and 12 health workers involved in PMTCT services. Participants answered semi-structured open ended questions related to their experiences with HIV services. Following transcription of interviews, data was analyzed using thematic coding for recurring themes. HIV-positive mothers cited their apprehension of the child's diagnosis, guilt of having infected the child, stigma, and unawareness as factors influencing utilization of pediatric HIV testing. Health workers-related barriers were lack of training, weak referral systems, sporadic testing days, and logistical challenges for DBS sample collection. Better counseling, referral systems, and training of health workers are needed to increase uptake of testing services for HIV-exposed children.