TIMELINESS OF EARLY INFANT HIV DIAGNOSIS AND ASSOCIATED FACTORS AMONG HIV-EXPOSED INFANTS IN PUBLIC HOSPITALS, ARSI ZONE, SOUTHEAST ETHIOPIA, 2025

Abstract

ABSTRACT Background: Early infant diagnosis (EID) is critical for reducing HIV-related morbidity and mortality among HIV-exposed infants. The World Health Organization recommends virological testing within 4–6 weeks after birth. However, many low-resource settings, including Ethiopia, continue to experience suboptimal performance in achieving the ≥95% timeliness target. Objective: To assess the timeliness of early infant HIV diagnosis and identify associated factors among HIV-exposed infants at public hospitals in Arsi Zone, Southeast Ethiopia. Methods: A facility-based cross-sectional study was conducted through retrospective chart reviews from August 30 to September 30, 2025. A consecutive sample of 414 mother-infant pairs was drawn from three randomly selected public hospitals. Data were collected using KoboToolbox and analyzed in SPSS version 27. Factors associated with early diagnosis were identified using bivariate and multivariable logistic regression, with results presented as adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: Among the 414 Human Immunodeficiency Virus-exposed infants enrolled (300 from Asella Referral and teaching Hospital, 62 from Robe Didea Hospital, and 52 from Abomsa Hospital), only 61.6% (255/414) had their first PCR sample collected within the recommended ≤45 days after birth. In multivariable analysis, reduced odds of timely EID were significantly associated with: maternal age <25 years (AOR = 0.043, 95% CI: 0.015–0.121) and >35 years (AOR = 0.257, 95% CI: 0.103–0.641); single (AOR = 0.119, 95% CI: 0.028–0.502) and divorced (AOR = 0.103, 95% CI: 0.025–0.427) marital status; rural residence (AOR = 0.124, 95% CI: 0.056–0.276); no antenatal care follow-up (AOR = 0.163, 95% CI: 0.076–0.349); home delivery (AOR = 0.083, 95% CI: 0.033–0.211); and mixed breastfeeding (AOR = 0.126, 95% CI: 0.049–0.321). Conclusion and recommendations: Early infant diagnosis timeliness in the Arsi Zone remains substantially below the global target. Interventions should prioritize young and older mothers, unmarried women, rural residents, and those with home deliveries or inadequate antenatal care to improve early infant diagnosis coverage. Keywords: Early infant diagnosis, HIV-exposed infants, polymerase chain reaction, timeliness, Ethiopia, Arsi Zone