Dr Angela Mushavi from the
Ministry of Health in Zimbabwe described implementation of early infant
diagnosis (EID). A nationwide programme was put in place, providing screening
of children for HIV exposure at all contact points with the health care
facility and included PMTCT sites, malnutrition clinics, ART/TB adult clinics,
well baby under-five clinics (U5C), sick outpatient and inpatient clinics, and
Sixty-nine per cent of HIV exposed infants
were identified at the U5Cs and 14% at the PMTCT clinics.
Having PITC at all entry
points does not guarantee comprehensive coverage or that caregivers will get
the results. In the MSF Bulawayo programme 99% of mothers who were part of a
mentor-mother programme (M2M) had their infant tested for HIV compared to less
than 50% of mothers not in the M2M programme. Similarly, those mothers who were
supported were more likely to get the results.
Improving retention is
critical for treatment and care programmes to be effective. Over 50% of mothers
(out of less than a quarter currently accessing care) will be lost at some
point along the continuum of care.
Pregnant women are less
likely to be retained in care than non-pregnant women in the same age group and
young pregnant women have the poorest rates of retention in care.
Adolescents and those under
two years of age have the greatest risk for loss to follow-up (LTFU). Reasons are
multiple and include: disclosure, death, transportation issues, refused care,
work commitments. Other factors that may overlap include financial barriers,
health system weaknesses, community factors and caregiver characteristics.
Dr Mbori-Ngacha highlighted
several examples of best practices for improving retention and rates of early
Uganda community volunteers accompanying children to clinics reduced loss to
follow-up by 69%.
transport vouchers in Uganda increased in-facility deliveries from 200 to 500 a
Africa using patient advocates within the service improved retention from 81.1%
Tanzania quality improvement reduced loss to follow-up from 22% to 14%.
In Zambia training providers reduced loss to
follow-up from 10.7 to 7.1%.
Malawi cell phones increased early infant diagnosis from 30 to 80%.
National paediatric HIV
clinic enrolment targets have been met in the rural Southern Rift Valley
Province, Kenya, with retention rates of over 80%, comparable to those of adults,
Argwings Miruka, presenting on behalf of the Walter Reed Project, Kericho, a
joint Kenyan and US government partnership, reported at the 19th International
Out of more than17,000
children tested for HIV between 2004 and 2011, over 5000 were enrolled in 57
HIV paediatric clinics. In 2011, 10.5% of HIV clinic attendees were children
(exceeding the national target of 10%), up from 7% in 2005 (p<0.001).
With an estimated 7000 to 10,000
children infected with HIV every year in Kenya, identifying and enrolling
children into care to meet the national target of 10% and keep them in care is
challenging, and often lags behind adult uptake.
Within rural settings extreme
poverty, malnutrition, the considerable distance to the nearest health clinic (on
average 15 kilometres) and frequent change of caregiver all compound the challenges.
With the support of the US
President’s Emergency Plan for AIDS Relief (PEPFAR) in 2004, HIV/AIDS treatment
and care programmes in the Southern Rift Valley were begun. Efforts to decentralise
care were made and clinics (ART sites) were brought closer to the rural
“Mwanganzi” or caregivers, often HIV-positive
adults, were recruited to bring the children to the clinics. Paediatric support
groups were formed where the children could also have fun. Caregivers were
trained and paediatric retreats with specialist trainings for health care
workers held. Service integration into other maternal and child health clinics has
begun and links to the community established.
With a mean age of 10 years
(6.7-13.3), half of the 5310 children enrolled into care between 2004 and 2011
In total, 44.3% started first-line ART,
2.5% switched to second-line treatment, and 1% started third-line
during the follow-up period.
Compared to the adult
retention rate on ART in 2011 of 82.2%, that of paediatric patients on ART was
Steps are being undertaken to
establish a specialist care hospital in the region. Malnutrition and transport
costs continue to prove challenging.
Targets can be met as long as
the psychosocial factors affecting the children are addressed along with the
key challenges, concluded Dr. Miruka.