Accessibility of healthcare facilities with early infant diagnosis for HIV a key barrier: Study

ICMR-NARI study identifies barriers in accessing Early Infant Diagnosis programme for HIV in India due to limited healthcare facility access and societal stigma.

A pan-India study conducted by Indian Council of Medical Research (ICMR)-National AIDS Research Institute (NARI) to identify the barriers and facilitators accessing the Early Infant Diagnosis (EID) programme for HIV in India concluded that one of the major obstacle to the programme is accessibility of healthcare facilities with EID services.

A total of 66 in-depth interviews were conducted with caregivers of HIV-exposed infants who were enrolled in these 31 centres for EID testing and had undergone at least one EID test from April 2017 to March 2018. (HT PHOTO)

The first-of-its-kind study titled, ‘Caregivers’ experiences of accessing HIV Early Infant Diagnosis Services and its Barriers and Facilitators, India’ was conducted in 31 integrated counselling and testing centres located in 11 high-burden HIV states.

The findings of the study were published in the BMC Health Services Research journal in January.

A total of 66 in-depth interviews were conducted with caregivers of HIV-exposed infants who were enrolled in these 31 centres for EID testing and had undergone at least one EID test from April 2017 to March 2018.

Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilisation from caregivers’ perspectives.

India in 2010 rolled out an Early Infant Diagnosis programme for HIV infection in all states. The EID programme consists of testing of infants exposed to HIV periodically over 18 months of age.

The infant has to be brought to the facility at least four times, i.e., at 6 weeks, 6 months, 12 months, 18 months, and more, if any test result is positive.

The EID programme aims at early initiation of infant Antiretroviral Therapy (ART) to reduce mortality and morbidity among HIV-infected infants.

The study was conducted as per the recommendations of the National AIDS Control Organisation (NACO). ICMR-NARI has shared their findings and suggestions with NACO for necessary changes in the programme.

The team of researchers and scientist included—Kalyani Nikhare, Nilesh Gawde, Suchit Kamble, Noopur Goel, Sushmita Kamble, Swapna Pawar, Pratik More, Neha Kapoor, Vinita Verma, Bhawani Singh Kushwaha, Chinmoyee Das and Shobini Rajan.

As per the study, ‘at health system level, accessibility of healthcare facilities with EID services was reported as a key barrier. The distance, time and cost were key concerns.

Many caregivers faced difficulties in remembering the details of the complex EID test schedule and relied on a phone call from the ICTC counsellor for the next due EID test.

Delayed EID test results and lack of communication of test results to caregivers were reported as primary barriers for completing the EID test cascade, revealed the study.

“The stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of ART for infants exposed to HIV,” mentioned Kalyani Nikhare, in the study report.

The study confers decentralisation and single window approaches can improve access, and timely communication of test results to the caregiver also needs to be built in with appropriate use of technology.

A holistic intervention including, people living with HIV support networks and peer-led support mechanisms would be useful to address societal factors.