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Community based early infant testing and treatment: experience from Blantyre, Malawi
A. Dow1, Q. Dube2, C.M. Chirambo2, M. Moore2, R. Heyderman2, A. Van Rie1
1University of North Carolina at Chapel Hill, Epidemiology, Chapel Hill, United States, 2Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
Background An estimated 370 000 children became newly infected in 2007 despite increasing access to PMTCT programs. The 2008 WHO guidelines recommend that infants in high HIV prevalence countries are screened for HIV exposure and, if exposed, have a virologic test at 4-6 weeks of age or the earliest opportunity thereafter.
Methods Free infant testing and treatment was made available at two clinics in Blantyre, Malawi as part of a community-based neurodevelopment and HIV research study. Women were informed on early infant testing and treatment and given educational fliers at PMTCT, 1 week and 6 week postnatal visits, and infant vaccination clinics. Six weeks testing was performed by HIV DNA PCR assay on dried blood spots.
Results During a six month period, 166 HIV-exposed infants were tested, and 35 infants identified as HIV-infected. Uptake of testing was lower than expected, with only 49% (166/340) of HIV-infected women presenting for infant testing at 6 weeks. Barriers to testing included poverty (lack of money for transport to primary health care clinic), stigma, especially when mothers had not disclosed her status, problems with identifying exposure status due to disconnects between mother and infant health records, and lack of awareness of infant testing and treatment in the community. Challenges to early ART initiation included mothers not returning for infant HIV test results, infant death prior to ART initiation, and refusal to start treatment in asymptomatic infants. Collection of contact information, tracing of mothers by community health volunteers and community sensitization using theater increased uptake of testing and treatment.
Conclusions Important barriers to early infant testing and treatment at primary health care clinics exist, resulting in a less than half of HIV-exposed infants being tested and a minority of HIV-infected children initiating ART in the first months of life.
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