Document Detail


Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi.
MedLine Citation:
PMID:  22984315     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Queen Dube; Anna Dow; Chawanangwa Chirambo; Jill Lebov; Lyson Tenthani; Michael Moore; Robert S Heyderman; Annelies Van Rie;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-06-18
Journal Detail:
Title:  Bulletin of the World Health Organization     Volume:  90     ISSN:  1564-0604     ISO Abbreviation:  Bull. World Health Organ.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-17     Completed Date:  2013-02-27     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  7507052     Medline TA:  Bull World Health Organ     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  699-704     Citation Subset:  IM    
Affiliation:
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi.
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MeSH Terms
Descriptor/Qualifier:
AIDS Serodiagnosis / methods*
Age Factors
Anti-HIV Agents / therapeutic use*
Child, Preschool
Confidence Intervals
Female
HIV Infections / diagnosis*,  drug therapy
Humans
Infant
Infant Welfare*
Infant, Newborn
Infectious Disease Transmission, Vertical / prevention & control
Malawi
Male
Polymerase Chain Reaction
Predictive Value of Tests
Pregnancy
Primary Health Care / methods*
Time Factors
Grant Support
ID/Acronym/Agency:
R01 HD053216/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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