Early infant diagnosis of HIV in three regions in Tanzania; successes and challenges

Chiduo, Mercy G.; Mmbando, Bruno P.; Theilgaard, Zahra Persson; Bygbjerg, Ib Christian; Gerstoft, Jan; Lemnge, Martha; Katzenstein, Terese L.

doi:10.1186/1471-2458-13-910

Cited by 34 publications

(38 citation statements)

References 14 publications

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“…In a recent study in five districts of central Malawi assessing the impact of Option B+, documentation of baseline characteristics and follow‐up parameters of HIV‐exposed infants was poor at 27%, with only 20% of infants having EID performed; and median age of testing varied from 10 to 16 weeks . Similar to our study, other recent studies from Mozambique , Nigeria , Tanzania and the Democratic Republic of the Congo have found large losses to follow‐up in HIV‐exposed infants, especially in relation to EID, where similar to the findings of our study infants also often come late for testing . Ways to reduce losses to follow‐up need to be found.…”

Section: Discussionsupporting

confidence: 89%

Follow‐up and programmatic outcomes of HIV‐exposed infants registered in a large HIV centre in Lilongwe, Malawi: 2012–2014

Ng’ambi

Adè

Harries

et al. 2016

Tropical Med Int Health

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Abstractobjective To assess follow-up and programmatic outcomes of HIV-exposed infants at Martin Preuss Centre, Lilongwe, from 2012 to 2014.methods Retrospective cohort study using routinely collected HIV-exposed infant data. Data were analysed using frequencies and percentages in Stata v.13.results Of 1035 HIV-exposed infants registered 2012-2014, 79% were available to be tested for HIV and 76% were HIV-tested either with DNA-PCR or rapid HIV test serology by 24 months of age. Sixty-five infants were found to be HIV-positive and 43% were started on antiretroviral therapy (ART) at different ages from 6 weeks to 24 months. Overall, 48% of HIV-exposed infants were declared lost-to-follow-up in the database. Of these, 69% were listed for tracing; of these, 78% were confirmed as lost-to-follow-up through patient charts; of these, 51% were traced; and of these, 62% were truly not in care, the remainder being wrongly classified. Commonest reasons for being truly not in care were mother/guardian unavailability to bring infants to Martin Preuss Centre, forgetting clinic appointments and transport expenses. Of these 86 patients, 36% were successfully brought back to care and 64% remained lost-to-follow-up.

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Section: Discussionsupporting

confidence: 89%

Follow‐up and programmatic outcomes of HIV‐exposed infants registered in a large HIV centre in Lilongwe, Malawi: 2012–2014

Ng’ambi

Adè

Harries

et al. 2016

Tropical Med Int Health

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“…However, EID rates are substantially below what has been estimated by other studies (Chiduo et al 2013). …”

Section: Infant Testingcontrasting

confidence: 43%

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

Nance¹,

McCoy²,

Ngilangwa³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programs. We are the global leader in funding, producing and synthesizing high-quality evidence of what works, for whom, why and at what cost. We believe that high-quality and policy-relevant evidence will help make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report3ie accepted the final version of this report, Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania, as partial fulfilment of the requirements of grant TW7.18 issued under Thematic Window 7. The content has been copy-edited and formatted for publication by 3ie. Some of the content does not conform to the series report norms or standards, but has been accepted as is. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors and omissions are the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author, Sandra I McCoy, smccoy@berkeley.edu. AcknowledgementsThe authors would first and foremost like to extend our gratitude toward 3ie for funding this evaluation. We would like to thank the Ministry of Health and Social Welfare of Tanzania, and in particular the Shinyanga Regional Medical Officer Dr Ntuli Kapologwe; without their support, this project would not have been possible.We would also like to thank administrative and research staff at Amref Health Africa and University of California, Berkeley, whose collaboration on the project has been essential. We thank Karen Webb and Barbara Engelsmann at the Organisation for Public Health Interventions and Development in Zimbabwe. Lastly, but most importantly, we are thankful to the health facility staff and other local stakeholders who supported this project, and to the research assistants and the impact evaluation field coordinator who collected the data showcased here.ii Summary Community health workers are key frontline health paraprofessionals who have the potential to enhance the World Health Organization's Option B+ strategy to eliminate mother-to-child transmission of HIV. By extending the reach of health services into communities facing a shortage of skilled health workers, community health workers may enhance retention in prevention of mother-to-child transmission (PMTCT) services, including HIV care and adherence to antiretroviral therapy.To test this hypothesis, we evaluated the Mama na Mtoto Pamoja (Mother and Child Together) intervention that integrated community healt...

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“…This figure is small as compared to the study at St. Luke hospital, Gondar University Referral hospital, and Tanzania [17–19]. Infants who took PMTCT "Option B+" were all negative for HIV at 6–8 weeks while those who didn’t take any prophylaxis or those who took single dose Nevirapine had the highest infection rate.…”

Section: Discussionmentioning

confidence: 80%

Early infant diagnosis of HIV infection using DNA-PCR at a referral center: an 8 years retrospective analysis

et al. 2016

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BackgroundOver the last decade, Ethiopia adopted different strategies of prevention of mother to child transmission of HIV (PMTCT). Prior to implementation of Option A in 2011, there was no provision of prophylaxis for PMTCT. With ‘Option A’, PMTCT interventions relied on maternal CD4 count. In early 2013, ‘‘Option B+’’ has been started; with this option, antiretroviral therapy is started and continued for life to any HIV positive pregnant mother irrespective of CD4 count with an enhanced treatment for the baby. Though there are a number of studies which evaluated the effectiveness of PMTCT interventions, the current study assessed the real-world effectiveness of PMTCT options in a setting where there is limitation of resources.ObjectiveThis study tried to address three questions: what proportion of babies tested by DNA-PCR are HIV infected in the first 2 months of life? How does the type of PMTCT intervention affect presence of HIV infection at this age? What are the factors affecting HIV transmission, after controlling for type of PMCT-HIV intervention?MethodsWe assessed records of 624 registered HIV exposed infants and 412 mothers who were delivered at Bishoftu Hospital from May 2006 to August 2014. Presence of HIV infection at 6–8 weeks of age was assessed from the records. Maternal and infant risk factors for infection at this age were analyzed. Data were collected using standard data abstraction format and were analyzed using SPSS version 20.ResultsAmong all the infants who were delivered at the hospital during the study period, 624/936 (66.7 %) had undergone early infant diagnosis at 6–8 weeks. Twenty-seven (4.3 %) were positive for HIV DNA PCR at the age of 6–8 weeks. None of the infants who received ‘‘Option B+’’ had a positive HIV DNA PCR result. HIV infection rate was highest among those who took either no prophylaxis or single dose Nevirapine (11.5 and 11.1 % respectively). Those who took single dose Nevirapine and Zidovudine had HIV positivity rate of 3.9 %. Many of the covariates which were shown to be predictors on bivariate analysis were found not to be independent predictors on multivariate analysis.ConclusionPMTCT ‘’Option B+’’ resulted in zero HIV infection rates among the included infants. There was a high loss to follow up rate at 6–8 weeks of age. The authors recommend that a better strategy of linkage to care and treatment should be devised for HIV exposed infants.

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Early infant diagnosis of HIV in three regions in Tanzania; successes and challenges

Cited by 34 publications

References 14 publications

Follow‐up and programmatic outcomes of HIV‐exposed infants registered in a large HIV centre in Lilongwe, Malawi: 2012–2014

Follow‐up and programmatic outcomes of HIV‐exposed infants registered in a large HIV centre in Lilongwe, Malawi: 2012–2014

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

Early infant diagnosis of HIV infection using DNA-PCR at a referral center: an 8 years retrospective analysis

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