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

Maureen Braun, Mark M. Kabue, Eric 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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
Volume56
Issue number5
DOIs
StatePublished - Apr 15 2011
Externally publishedYes

Fingerprint

Malawi
Early Diagnosis
Mothers
HIV
DNA-Directed DNA Polymerase
Pediatrics
HIV Antibodies
Polymerase Chain Reaction
Therapeutics
Continuity of Patient Care
Survival
Delayed Diagnosis
Infant Mortality

Keywords

  • Africa
  • antiretroviral therapy
  • early infant diagnosis
  • HIV testing
  • pediatric HIV,Malawi
  • prevention of mother-to-child transmission

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in lilongwe, Malawi. / Braun, Maureen; Kabue, Mark M.; McCollum, Eric; Ahmed, Saeed; Kim, Maria; Aertker, Leela; Chirwa, Marko; Eliya, Michael; Mofolo, Innocent; Hoffman, Irving; Kazembe, Peter N.; Van Der Horst, Charles; Kline, Mark W.; Hosseinipour, Mina C.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 56, No. 5, 15.04.2011.

Research output: Contribution to journalArticle

Braun, M, Kabue, MM, McCollum, E, Ahmed, S, Kim, M, Aertker, L, Chirwa, M, Eliya, M, Mofolo, I, Hoffman, I, Kazembe, PN, Van Der Horst, C, Kline, MW & Hosseinipour, MC 2011, 'Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in lilongwe, Malawi', Journal of Acquired Immune Deficiency Syndromes, vol. 56, no. 5. https://doi.org/10.1097/QAI.0b013e31820a7f2f
Braun, Maureen ; Kabue, Mark M. ; McCollum, Eric ; Ahmed, Saeed ; Kim, Maria ; Aertker, Leela ; Chirwa, Marko ; Eliya, Michael ; Mofolo, Innocent ; Hoffman, Irving ; Kazembe, Peter N. ; Van Der Horst, Charles ; Kline, Mark W. ; Hosseinipour, Mina C. / Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in lilongwe, Malawi. In: Journal of Acquired Immune Deficiency Syndromes. 2011 ; Vol. 56, No. 5.
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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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AU - Kabue, Mark M.

AU - McCollum, Eric

AU - Ahmed, Saeed

AU - Kim, Maria

AU - Aertker, Leela

AU - Chirwa, Marko

AU - Eliya, Michael

AU - Mofolo, Innocent

AU - Hoffman, Irving

AU - Kazembe, Peter N.

AU - Van Der Horst, Charles

AU - Kline, Mark W.

AU - Hosseinipour, Mina C.

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N2 - 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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KW - antiretroviral therapy

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KW - HIV testing

KW - pediatric HIV,Malawi

KW - prevention of mother-to-child transmission

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