Missed Opportunities for Early Access to Care of HIV-Infected Infants in Burkina Faso

Abstract

ObjectiveThe World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso.MethodsWe conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW).ResultsIn 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%–1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW.ConclusionsThe PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou.

Optimizing Infant HIV Diagnosis in Resource-Limited Settings: Modeling the Impact of HIV DNA PCR Testing at Birth

“…Based on current published data on linkage to care for HIV-infected infants in sub-Saharan Africa, we estimated that 52% of infants identified as HIV infected would enroll into care, 16,19,28-31 and 54% of those enrolled into care would initiate ART. 16,19,31 To determine the age at ART initiation, we assumed a median time of 10 weeks from the time of HIV diagnosis to the time of ART initiation.…”

“…16,19,31 To determine the age at ART initiation, we assumed a median time of 10 weeks from the time of HIV diagnosis to the time of ART initiation. 14,17,31 We used these same assumptions regardless of the testing algorithm or the infant’s age at HIV diagnosis.…”

Pediatric Human Immunodeficiency Virus Continuum of Care

“…In Burkino Faso, a study evaluating a mother to child transmission prevention program described pregnant women being tested for HIV in one prenatal HIV clinic and being referred for testing and treatment in three separate health care facilities before returning for further prenatal counseling. 49 Shortages in health care workers and inadequate health care training can result in insufficient services. For example, HIV testing for infants may only be offered on one day of each month despite recommended testing at specific time intervals after birth.…”

“…For example, HIV testing for infants may only be offered on one day of each month despite recommended testing at specific time intervals after birth. 49 …”

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

“…Nigeria's high child mortality rates, high child HIV prevalence and AIDS-related deaths make SDG 3 of prime importance. HIV-exposed infants (HEI) who die before determination of HIV status or anti-retroviral therapy (ART) initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality in the context of the prevention of mother-to-child transmission of HIV (PMTCT) (8)(9)(10). There is little available data on mortality and attributable causes of death speci c to HEI in Nigeria.…”