Transcript EID Implementation Challenges

EID Implementation
Challenges
Dr Angela Mushavi, Zim National PMTCT and
Pediatric HIV Care and Treatment Coordinator
XV111 IAS Conference
18-24th July, 2010
Vienna, Austria
EID program in Zimbabwe
• EID started as a pilot in 4 sites: Harare,
Chitungwiza, Mpilo, Parirenyatwa hospitals in
2007
• SOP, data forms, algorithm (to be finalized)
developed
• Training of multi-disciplinary health workers
• National Microbiology Reference Laboratory
(NMRL) & a partner lab (Zvitambo) responsible
for analysis
• CHAI supports reagents and human resources
• EMS system for transportation of specimens to
and from sites and lab
DBS specimens from few implementing
sites in 2010
Name
of site
Jan
Feb
March
Total #
of
Samples
in
quarter
1
Estimate Testing
d
rate
number
of HIV
positive
mothers
1
2
3
6
11
55%
-
-
-
0
68
0
-
3
3
6
27
22%
-
4
4
8
23
35%
-
-
4
4
24
17%
Tafara FHS Princess
Margret
Rose
2
2
4
17
24%
3
3
6
19
32%
Belvedere
Clinic
Edith
Opperman
Clinic
Greendale
Clinic
Hatfield
PCC
Nhowe
Hospital
2009 DNA-PCR Tests
• Two laboratories with PCR capacity:
-National Microbiology Reference Lab (NMRL)
-Zvitambo Lab
• Current lab capacity to perform 24 000 HIV DNA
PCR tests
.
• 4 143 PCR tests done in 2009, 846 (20.4%) were
positive and 3 297 (79.6%) were negative (Not
disaggregated by age at test)
• National coverage of EID is 13% out of all HIVexposed infants
• Only 76 sites submitting DBS
Enrolling HIV exposed and
infected Children into Care
• With PITC, all children presenting for any health
service should be offered HIV testing:
– 6 weeks postnatal visit for babies from PMTCT
(increasingly)
– All children presenting for routine child health care
interventions, e.g. GMP (ask for and/check HIV-exposure
status on child health card)
– Inpatient and outpatient symptomatic children
– New start centre (VCT)
– TB hospital
– Nutrition rehabilitation centre
– Children whose parents are on ART or in pre-ART
EID: the reality
• Our treatment data tells us that many of the children on ART are
older; not infants
• Even with the adoption of PITC by MOHCW, question is: To
what extent is this happening for children in-country? Figures
clearly show that infant testing rates are low
• Staff that are trained lack confidence to perform DBS on babies,
and there is delay in starting to submit samples by recently
trained staff
• Sites do not always have staff trained in EID, and therefore do
not submit DBS
• For some of those sites that have been trained in DBS, there
are no bundles available
• The result: HIV-infected children die needlessly before they
even go on ART; or much later when they advanced HIV
disease
Take home message
• Enhancing laboratory capacity to test is
excellent; but EID programs should create health
care worker momentum for early testing of
children
• Community mobilization to increase demand for
early HIV testing of children
• Training, mentorship and supportive supervision
of health care workers in DBS collection is
critical
• Provide adequate training and supplies to
conduct DBS collection
Thank you