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.
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• 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
  • HIV Antibodies
  • HIV Infections
  • HIV-1
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• Keywords:
  • Africa
  • antiretroviral therapy
  • early infant diagnosis
  • HIV testing
  • pediatric HIV
  • prevention of mother-to-child transmission
  • Malawi
• 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/
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• Volume:
  56
• Issue:
  5
• Download URL:
  https://stacks.cdc.gov/view/cdc/33209/cdc_33209_DS1.pdf
• File Type:
  [PDF - 107.25 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d8eea705f57ee0c4e4bb5716d068951c4b2a4e11fc77853e40edc2f816e74936