Barriers to Successful Early Infant Diagnosis of HIV Infection at Primary Care Level in Malawi

Cromwell, Elizabeth A.; Dow, Anna; Low, Daniel; Chirambo, Chawanangwa; Heyderman, Robert S.; Dube, Queen; Rie, Annelies Van

doi:10.1097/inf.0000000000000625

Cited by 20 publications

(17 citation statements)

References 6 publications

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“…In line with previous studies, we showed that children born to women who received ART are less likely to be lost to follow-up and more likely to be tested for HIV [15–18]. Efforts to increase retention and HIV testing could improve the diagnosis of HIV-infected children and their access to ART.…”

Section: Discussionsupporting

confidence: 88%

“…Neither of the two studies adjusted for missing data in children who were lost to follow-up. As children at higher risk of mother-to-child transmission are underrepresented in routine PMTCT programmes, both studies will have underestimated the risk of mother-to-child-transmission in the Option B+ programme [15–18]. The present analysis shows that the degree of underestimation can be substantial.…”

Section: Discussionmentioning

confidence: 74%

“…Children at higher risk of HIV transmission (i.e. those born to mothers not on ART) are less likely to be retained in care and tested for HIV and thus are underrepresented in routinely collected national data [15–18]. For these reasons, the overall effectiveness of Option B+ for PMTCT at the end of breastfeeding is currently unknown.…”

Section: Introductionmentioning

confidence: 99%

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HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Haas

Oosterhout

Tenthani

et al. 2017

Journal of the International AIDS Society

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Introduction: In Malawi, HIV-infected pregnant and breastfeeding women are offered lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage (Option B+). Their HIV-exposed children are enrolled in the national prevention of mother-to-child transmission (PMTCT) programme, but many are lost to follow-up. We estimated the cumulative incidence of vertical HIV transmission, taking loss to follow-up into account. Methods: We abstracted data from HIV-exposed children enrolled into care between September 2011 and June 2014 from patient records at 21 health facilities in central and southern Malawi. We used competing risk models to estimate the probability of loss to follow-up, death, ART initiation and discharge, and used pooled logistic regression and inverse probability of censoring weighting to estimate the vertical HIV transmission risk. Results: A total of 11,285 children were included; 9285 (82%) were born to women who initiated ART during pregnancy. At age 30 months, an estimated 57.9% (95% CI 56.6–59.2) of children were lost to follow-up, 0.8% (0.6–1.0) had died, 2.6% (2.3–3.0) initiated ART, 36.5% (35.2–37.9) were discharged HIV-negative and 2.2% (1.5–2.8) continued follow-up. We estimated that 5.3% (95% CI 4.7–5.9) of the children who enrolled were HIV-infected by the age of 30 months, but only about half of these children (2.6%; 95% CI 2.3–2.9) were diagnosed. Conclusions: Confirmed mother-to-child transmission rates were low, but due to poor retention only about half of HIV-infected children were diagnosed. Tracing of children lost to follow-up and HIV testing in outpatient clinics should be scaled up to ensure that all HIV-positive children have access to early ART.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 74%

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HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Haas

Oosterhout

Tenthani

et al. 2017

Journal of the International AIDS Society

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“…[14] Recommendations indicate that if an appointment is scheduled with a woman to receive test results (step 4), it either needs to be kept or the woman needs to be contacted to reschedule the appointment. One study found that HIV-infected mothers enrolled in HIV care were less likely to fail to return for their infant's HIV test result (aRR 0.51; 95% CI (0.3 -0.9), [5] therefore providing ART to all pregnant women may lead to a better return. This is encouraging for Malawi, which is implementing lifelong ART for all HIV-positive pregnant women regardless of CD4 count.…”

Section: Discussionmentioning

confidence: 99%

“…The main barriers were expense due to travel time and costs (adjusted risk ratio (aRR) 1.93; 95% confidence interval (CI) 1.1 -3.4), and disclosure by women to their husbands or partners that the infant was being tested (aRR 1.97; 95% CI: 1.0 -3.8). [5] Policy changes in Malawi that support ART initiation for HEI include the Paediatric HIV Care Scale-up Plan (2009 -2013), which authorised all levels of healthcare workers (HCWs) to prescribe ART. However, in practice, paediatric HIV testing, care and treatment were not adequately provided in facilities.…”

mentioning

confidence: 99%

Barriers, facilitators and recommendations for the early infant diagnosis and treatment (EIDT) cascade: A qualitative study in Malawi

et al. 2016

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Semistructured interviews were conducted with HCWs who were involved with EIDT activities, and with mothers of HEIs. Convenience sampling was utilised to recruit participants. Ethical approval was received from the Malawi National Health Sciences Research Committee (NHSRC). Settings and participantsThe study was conducted within five purposively selected health facilities within three districts in Malawi that were supported with funding from ViiV-Healthcare to the Elizabeth Glaser Pediatric

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A mobile health‐facilitated behavioural intervention for community health workers improves exclusive breastfeeding and early infant HIV diagnosis in India: a cluster randomized trial

Suryavanshi¹,

Kadam²,

Gupte

et al. 2020

J Intern AIDS Soc

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IntroductionIndia’s national AIDS Control Organization implemented World Health Organization’s option B+ HIV prevention of mother‐to‐child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health‐Facilitated Behavioral Intervention on the uptake of PMTCT services.MethodsA cluster‐randomized trial of a mobile health (mHealth)‐supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV‐positive pregnant/postpartum clients (n = 1191)) were randomized to standard‐of‐care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention – specialized behavioural training plus a tablet‐based mHealth application to support ORW‐patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi‐level random‐effects logistic regression models.ResultsOf 1191 HIV‐positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC.ConclusionsThe COMBIND intervention was easily integrated into India’s existing PMTCT programme and improved early uptake of two PMTCT components that require self‐motivated health‐seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes.

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Barriers to Successful Early Infant Diagnosis of HIV Infection at Primary Care Level in Malawi

Cited by 20 publications

References 6 publications

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Barriers, facilitators and recommendations for the early infant diagnosis and treatment (EIDT) cascade: A qualitative study in Malawi

A mobile health‐facilitated behavioural intervention for community health workers improves exclusive breastfeeding and early infant HIV diagnosis in India: a cluster randomized trial

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