Inadequate Coordination of Maternal and Infant HIV Services Detrimentally Affects Early Infant Diagnosis Outcomes in Lilongwe, Malawi

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Braun, M. ; Kabue, M.M. ; McCollum, E.D. ; Ahmed, S. ; Kim, M. ; Aertker, L. ; Chirwa, M. ; Eliya, M. ; Mofolo, I. ; Hoffman, I. ; Kazembe, P.N. ; van der Horst, C. ; Kline, M.W. ; Hosseinipour, M. C.
• Description:
  Objective
  
  To assess the continuity of care and outcome of pediatric HIV prevention, testing, and treatment services, focusing on early infant diagnosis with DNA PCR.
  
  Design
  
  A retrospective observational cohort.
  
  Methods
  
  Maternal HIV antibody, infant HIV DNA PCR test results, and outcome data from HIV-infected infants from the prevention of mother-to-child transmission, early infant diagnosis, and pediatric HIV treatment programs operating in Lilongwe, Malawi between 2004 and 2008 were collected, merged and analyzed.
  
  Results
  
  Of the 14,669 pregnant women who tested HIV antibody positive, 7,875 infants (53.7%) received HIV DNA PCR testing. One thousand eighty-four infants (13.8%) were HIV-infected. 320 (29.5%) children enrolled into pediatric HIV care, with 202 (63.1%) at the Baylor Center of Excellence. Among these, antiretroviral therapy was initiated on 110 infants (54.5%) whose median age was 9.1 months (interquartile range, 5.4 to 13.8) and a median of 2.5 months (interquartile range, 1.4 to 9.2) after HIV clinic registration. Sixty-nine HIV-infected infants (34.2%) died or were lost by December 2008. Initiation of antiretroviral therapy increased the likelihood of survival seven-fold (odds ratio, 7.1; 95% confidence interval, 3.68 -13.70).
  
  Conclusions
  
  Separate programs for maternal and infant HIV prevention and care services demonstrated high attrition rates of HIV-exposed and HIV-infected infants, elevated levels of mother-to-child transmission, late infant diagnosis, delayed pediatric antiretroviral therapy initiation, and high HIV-infected infant mortality. Antiretroviral therapy increased HIV-infected infant survival, emphasizing the urgent need for improved service coordination and strategies that increase access to infant HIV diagnosis, improve patient retention, and reduce antiretroviral therapy initiation delays.
  
  
• Subjects:
  AIDS Serodiagnosis Antiretroviral Therapy, Highly Active Child Health Services Cohort Studies Delivery Of Health Care, Integrated Early Diagnosis Female Health Planning Guidelines HIV-1 HIV Antibodies HIV Infections Humans Infant Infant Mortality Infectious Disease Transmission, Vertical Malawi Male Maternal Health Services Polymerase Chain Reaction Pregnancy Pregnancy Complications, Infectious Retrospective Studies

  More +
• Keywords:
  Africa Antiretroviral Therapy Early Infant Diagnosis HIV Testing Pediatric HIV Prevention Of Mother-to-child Transmission
• Source:
  J Acquir Immune Defic Syndr. 56(5):e122-e128
• Pubmed ID:
  21224736
• Pubmed Central ID:
  PMC3112277
• Document Type:
  Journal Article
• Funding:
  U48 DP001944/DP/NCCDPHP CDC HHSUnited States/ ; D43 TW001039/TW/FIC NIH HHSUnited States/ ; #P30 AI50410/AI/NIAID NIH HHSUnited States/ ; T32 HL072748/HL/NHLBI NIH HHSUnited States/ ; R24 TW007988/TW/FIC NIH HHSUnited States/ ; R24 TW007988-03/TW/FIC NIH HHSUnited States/ ; 1U48DP001944/DP/NCCDPHP CDC HHSUnited States/ ; D43 TW001039-09/TW/FIC NIH HHSUnited States/ ; U48DP001944/ACL/ACL HHSUnited States/ ; D43 TW001036/TW/FIC NIH HHSUnited States/ ; P30 AI050410-08/AI/NIAID NIH HHSUnited States/ ; D43 TW01036/TW/FIC NIH HHSUnited States/ ; P30 AI050410/AI/NIAID NIH HHSUnited States/
• Volume:
  56
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d8eea705f57ee0c4e4bb5716d068951c4b2a4e11fc77853e40edc2f816e74936
• Download URL:
  https://stacks.cdc.gov/view/cdc/33209/cdc_33209_DS1.pdf
• File Type:
  [PDF - 107.25 KB ]