Implementing early infant diagnosis of HIV-infection at the primary care level : experiences and challenges in Malawi

Dube, Queen; Dow, Anna; Chirambo, Chawanangwa; Lebov, Jill; Tenthani, Lyson; Moore, Michael; Heyderman, Robert S.; Van Rie, Annelies

doi:10.2471/BLT.11.100776

Title

Implementing early infant diagnosis of HIV-infection at the primary care level : experiences and challenges in Malawi

Author

Dube, Queen

Dow, Anna

Chirambo, Chawanangwa

Lebov, Jill

Tenthani, Lyson

Moore, Michael

Heyderman, Robert S.

Van Rie, Annelies

Institution/Organisation

CHIDEV Study Team

Abstract

Problem Malawi's national guidelines recommend that infants exposed to the human immunodeficiency virus (HIV) be tested at 6 weeks of age. Rollout of services for early infant diagnosis has been limited and has resulted in the initiation of antiretroviral therapy (ART) in very few infants. Approach An early infant diagnosis programme was launched. It included education of pregnant women on infant testing, community sensitization, free infant testing at 6 weeks of age, active tracing of HIV-positive infants and referral for treatment and care. Local setting The programme was established in two primary care facilities in Blantyre, Malawi. Relevant changes Of 1214 HIV-exposed infants, 71.6% presented for early diagnosis, and 14.5% of those who presented tested positive for HIV. Further testing of 103 of these 126 apparently HIV-positive infants confirmed infection in 88; the other 15 results were false positives. The initial polymerase chain reaction testing of dried blood spots had a positive predictive value (PPV) of 85.4%. Despite active tracing, only 87.3% (110/126) of the mothers of infants who initially tested positive were told their infants' test results. ART was initiated in 58% of the infants with confirmed HIV infection. Lessons learnt Early infant diagnosis of HIV infection at the primary care level in a resource-poor setting is challenging. Many children in the HIV diagnosis and treatment programme were lost to follow-up at various stages. Diagnostic tools with higher PPV and point-of-care capacity and better infrastructures for administering ART are needed to improve the management of HIV-exposed and HIV-infected infants.

Language

English

Source (journal)

Bulletin of the World Health Organization. - Genève

Publication

Genève : 2012

ISSN

0042-9686

DOI

10.2471/BLT.11.100776

Volume/pages

90 :9 (2012) , p. 699-704