Document Detail


Superior uptake and outcomes of early infant diagnosis of HIV services at an immunization clinic versus an "under-five" general pediatric clinic in Malawi.
MedLine Citation:
PMID:  22614897     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Although the Malawian government recommends HIV-exposed infants receive early infant diagnosis (EID) of HIV at "under-five" pediatric clinics (U5Cs), most never enroll. Therefore, we evaluated the integration of EID testing into an immunization clinic (IC) compared with the current standard of EID testing at an U5C.
DESIGN: Prospective observational study.
METHODS: Using routine provider-initiated HIV testing and counseling (PITC) registers, we prospectively studied 1757 children offered PITC at a government IC and U5C. Infants tested by HIV DNA polymerase chain reaction (PCR) were followed until PCR result disclosure or defaulting.
RESULTS: We sampled 877 and 880 consecutive PITC recipients at U5C and IC, respectively. Overall, a 7-fold greater proportion received PITC at IC (84.2% vs. 11.4%, P < 0.001). PITC recipients at IC were more than 14 months younger (2.6 vs. 17.0, P < 0.001), with greater proportions HIV exposed (17.6% vs. 5.3%, P < 0.001) and PCR eligible (7.9% vs. 3.5%, P < 0.001). A higher percentage of IC infants accepted PCR testing (100.0% vs. 90.3%, P = 0.03). Additionally, IC PCR recipients were 2.5 months younger (3.1 vs. 5.6, P < 0.001) with 4 times less testing PCR positive (7.1% vs. 32.1%, P < 0.001). Importantly, a more than 3-fold greater proportion of HIV-exposed infants at IC returned for their PCR result and enrolled into care (78.6% vs. 25.0%, P < 0.001).
CONCLUSIONS: Compared with an U5C, integrating EID testing into an IC is more acceptable, more feasible, enrolls more infants into EID at younger ages, and would likely strengthen Malawi's EID services if expanded.
Authors:
Eric D McCollum; Derek C Johnson; Charles S Chasela; Linias D Siwande; Peter N Kazembe; Dan Olson; Irving Hoffman; Charles van der Horst; Mina C Hosseinipour
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  60     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-09     Completed Date:  2012-09-19     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e107-10     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Care Facilities / organization & administration*
Child, Preschool
DNA, Viral / genetics,  isolation & purification
Delivery of Health Care / organization & administration*
Female
HIV / genetics,  isolation & purification
HIV Infections / diagnosis*
Health Services Research*
Humans
Infant
Malawi
Male
Polymerase Chain Reaction
Prospective Studies
Grant Support
ID/Acronym/Agency:
5 P30-AI50410/AI/NIAID NIH HHS; P30 AI050410/AI/NIAID NIH HHS; R24 TW007988/TW/FIC NIH HHS; R24 TW007988/TW/FIC NIH HHS; T32 HL072748/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/DNA, Viral
Comments/Corrections

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