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ART initiation and increased survival of infants traced from PMTCT to pediatric HIV care: highlighting the need for program coordination in Lilongwe, Malawi
Presented by Maureen Braun (Malawi).
M.M. Kabue1, M. Braun2, L. Aetker2, M. Chirwa2, I. Mofolo2, I. Hoffman2, M. Hosseinipour2, P.N. Kazembe1, M.W. Kline3
1Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi, 2UNC Project, Lilongwe, Malawi, 3Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI), Houston, Texas, United States
Background: PMTCT programs can identify HIV exposed infants, but successful management of HIV infected children requires prompt referral to ART care. In Malawi, exposed babies are referred for HIV testing at 6 weeks. HIV infected infants are referred for care and those < 12 months initiate ART. We outline the clinical outcomes of HIV infected infants successfully referred from PMTCT programs to pediatric HIV care.
Methods: Using several electronic and paper-based sources of infant HIV test results, we compiled a comprehensive list of HIV positive infants and linked the PMTCT maternal data, infant testing data and pediatric HIV clinical outcomes for each infant to determine factors associated with successful clinical outcomes.
Results: Since 2004 we traced 178 HIV positive infants to care; 53.4% female, 82.6% < 12 months of age. Median ages of diagnosis and clinic enrollment were 89 and 161 days, respectively. Median time from HIV positive status to clinic presentation was 38.5 days (n = 132). 48.3% of infants initiated ART. ART initiators were somewhat younger at enrollment (median age 146 (IQR 73-242) vs. 175 (IQR 86.5-278) days). 33.7% of ART initiators presented with WHO stage 3 or 4 disease vs. 25% of non-initiators (p=0.20). Children initiating ART were 6 times more likely to be alive than those who did not, (OR=6.3 95% CI 3.1 - 13.2, p < 0.05). 8.5% of ART initiators died vs. 29.9% of non-initiators p = 0.0008).
Conclusions: Evaluation of infants traced from PMTCT to pediatric HIV services in Lilongwe showed increased survival of infants on ART. Our data show improvements are needed in age at both diagnosis and clinic enrollment. In order to increase survival of HIV positive infants, PMTCT, infant testing, and pediatric HIV services must coordinate a testing and referral system employing consistent timelines and procedures to ensure prompt infant diagnosis and ART initiation.
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