Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi
| Autor: | Lyson Tenthani, Michael Moore, Jill F. Lebov, Robert S. Heyderman, Annelies Van Rie, Anna Dow, Queen Dube, Chawanangwa Chirambo |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
Malawi Time Factors Primary Health Care Anti-HIV Agents Age Factors Infant Welfare Infant Newborn Public Health Environmental and Occupational Health AIDS Serodiagnosis Infant HIV Infections Polymerase Chain Reaction Infectious Disease Transmission Vertical Predictive Value of Tests Pregnancy Child Preschool Lessons from the Field parasitic diseases Confidence Intervals Humans Female |
| DOI: | 10.17615/fj65-4n95 |
| Popis: | 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.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.The programme was established in two primary care facilities in Blantyre, Malawi.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.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. |
| Databáze: | OpenAIRE |
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