Predictors of Retention Among HIV Exposed Infants in the Early Infant Diagnosis Program in Lilongwe Rural, Malawi.

BACKGROUND: The Early Infant Diagnosis (EID) Program exists to improve the identification of HIV-exposed infants(HEIs) to accelerate linkage to care. The trends of retention in EID have been 88%, 91% and 93% retention at 24th month age cohort in the last quarter of 2022, 2023 and 2024 respectively. However, these rates varied across health facilities, with some reporting much lower retention. This study explored factors influencing the retention of HEIs within the program. METHODS: We conducted a barrier analysis study at four facilities. We recruited 90 HIV-exposed infants 0-24 months of age purposively: 45 doers (retained in care) and 45non-doers (not retained in care). The independent variables were self-efficacy, social norms, access, culture, and religion. The dependent variable was retention. RESULTS: Distance to the health facility (p = 0.001), mothers'/caregivers' willingness to seek services (p = 0.006), absence of a life partner (p = 0.004), and approval and support from partners, family members, and the community (p = 0.049) were significant determinants of clients' utilization of early infant diagnosis (EID) program services. These findings suggest that both structural factors (e.g., distance to health facilities) and social factors (e.g., life partner, family and community support) play important roles in influencing the uptake of EID services. CONCLUSION: These findings highlight the need for multifaceted interventions that address health system, behavioral, and social determinants simultaneously to improve retention in EID services.