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. 2011 Apr 15;56(5):e122-8.
doi: 10.1097/QAI.0b013e31820a7f2f.

Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in Lilongwe, Malawi

Maureen Braun  1 , Mark M Kabue, Eric D McCollum, Saeed Ahmed, Maria Kim, Leela Aertker, Marko Chirwa, Michael Eliya, Innocent Mofolo, Irving Hoffman, Peter N Kazembe, Charles van der Horst, Mark W Kline, Mina C Hosseinipour
Affiliations

Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in Lilongwe, Malawi

Maureen Braun et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: To assess the continuity of care and outcome of pediatric HIV prevention, testing, and treatment services, focusing on early infant diagnosis with DNA polymerase chain reaction (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, 7875 infants (53.7%) received HIV DNA PCR testing. One thousand eighty-four infants (13.8%) were HIV infected. Three hundred twenty (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, 5.4-13.8) and a median of 2.5 months (interquartile range, 1.4-5.2) 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 7-fold (odds ratio, 7.1; 95% confidence interval, 3.68 to 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.

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Figures

Figure 1
Figure 1
Cascade of PMTCT and Pediatric HIV services in Lilongwe Malawi, 2004-2008. PMTCT- Prevention of Mother to Child Transmission. COE. Centre of Excellence
Figure 2
Figure 2
Kaplan Meier Survival Analysis of 202 children attending the Baylor Center of Excellence in Lilongwe Malawi. ART, antiretroviral therapy.
See this image and copyright information in PMC

References

    1. UNICEF . Children and AIDS. Third Stocktaking Report 2008. New York, USA: UNICEF; 2008.
    1. UNICEF . Towards universal access: scaling up priority HIV services for women and children in the health sector- progress report 2008. New York, USA: UNICEF; 2008. United Nations Children's Fund, Joint United Nations Programme on HIV/AIDS and the World Health Organization.
    1. UNICEF . AIDS Epidemic Update 2007. Geneva: UNAIDS; 2007.
    1. Chilongozi D, Wang L, Brown L, Taha T, Valentine M, Emel L, et al. Morbidity and mortality among a cohort of human immunodeficiency virus type 1-infected and uninfected pregnant women and their infants from Malawi, Zambia, and Tanzania. Pediatr Infect Dis J. 2008;27:808–14. - PMC - PubMed
    1. Central Intelligence Agency . The World Factbook 2009. Washington, DC: Central Intelligence Agency; 2009.

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