Improved identification and enrolment into care of HIV‐exposed and ‐infected infants and children following a community health worker intervention in Lilongwe, Malawi

Abstract

BackgroundEarly identification and entry into care is critical to reducing morbidity and mortality in children with HIV. The objective of this report is to describe the impact of the Tingathe programme, which utilizes community health workers (CHWs) to improve identification and enrolment into care of HIV-exposed and -infected infants and children.MethodsThree programme phases are described. During the first phase, Mentorship Only (MO) (March 2007–February 2008) on-site clinical mentorship on paediatric HIV care was provided. In the second phase, Tingathe-Basic (March 2008–February 2009), CHWs provided HIV testing and counselling to improve case finding of HIV-exposed and -infected children. In the final phase, Tingathe-PMTCT (prevention of mother-to-child transmission) (March 2009–February 2011), CHWs were also assigned to HIV-positive pregnant women to improve mother-infant retention in care. We reviewed routinely collected programme data from HIV testing registers, patient mastercards and clinic attendance registers from March 2005 to March 2011.ResultsDuring MO, 42 children (38 HIV-infected and 4 HIV-exposed) were active in care. During Tingathe-Basic, 238 HIV-infected children (HIC) were newly enrolled, a six-fold increase in rate of enrolment from 3.2 to 19.8 per month. The number of HIV-exposed infants (HEI) increased from 4 to 118. During Tingathe-PMTCT, 526 HIC were newly enrolled over 24 months, at a rate of 21.9 patients per month. There was also a seven-fold increase in the average number of exposed infants enrolled per month (9.5–70 patients per month), resulting in 1667 enrolled with a younger median age at enrolment (5.2 vs. 2.5 months; p<0.001).During the Tingathe-Basic and Tingathe-PMTCT periods, CHWs conducted 44,388 rapid HIV tests, 7658 (17.3%) in children aged 18 months to 15 years; 351 (4.6%) tested HIV-positive. Over this time, 1781 HEI were enrolled, with 102 (5.7%) found HIV-infected by positive PCR. Additional HIC entered care through various mechanisms (including positive linkage by CHWs and transfer-ins) such that by February 2011, a total of 866 HIC were receiving care, a 23-fold increase from 2008.ConclusionsA multipronged approach utilizing CHWs to conduct HIV testing, link HIC into care and provide support to PMTCT mothers can dramatically improve the identification and enrolment into care of HIV-exposed and -infected children.

Burden of disease and risk factors for death among children treated for tuberculosis in Malawi

“…There is an urgent need for pediatric-specific strategies for intensified case finding and improved management of HIV-infected children on ART. Given the success of community health worker-driven interventions in addressing pediatric HIV in this setting, 16,17,36 we are using this data to integrate pediatric TB case-finding and management into an existing community health worker focused intervention.…”

“…16,17 Hospitals and health centers vary primarily by the concentration of infrastructure and experienced personnel—hospitals often have at least one medical doctor on staff, and may have access to chest radiography, whereas health centers typically do not.…”

A comprehensive review of the barriers and promoters health workers experience in delivering prevention of vertical transmission of HIV services in sub-Saharan Africa

“…Early community health worker engagement increases enrollment of HIV-exposed and -infected infants and young children in care (Ahmed et al, 2015) and positively influences exclusive breastfeeding and child growth (Tomlinson et al, 2014). However, this review found lay and community-based health workers’ to have unclear status and roles, which can lead to health workers performing tasks outside their training or not living up to expectations.…”

Beyond early infant diagnosis

“…The Tingathe Program in Malawi utilizes community health workers to conduct community-based HIV testing and case finding resulting in more than 2500 HIV-exposed and HIV-infected children enrolled in care from 2008 to 2011. A 10-fold increase in enrollment of HIV-infected children into care from 3.2/month preintervention to 32.7/month postintervention was observed [55,76,77]. In Tanzania, a community-based testing campaign focused on children called Know Your Child’s Status conducted 2994 tests in children with 108 new cases identified (3.6%) [78].…”