Transcript Integration of Early Infant HIV Diagnosis (EID) with Child

Scaling up Early Infant HIV Diagnosis
(EID) in Karamoja
Health Nutrition HIV coordination
meeting
9th December 2009
Background
• Over 2 years since the testing of HIV among exposed
infants started in Uganda; over 1 year in Karamoja
region.
• EID program enables testing of infants as early as 6
weeks.
• Currently there are 8 labs with DNA PCR technology in
the different regions of the country.
• Karamoja is served by JCRC Mbale referral hospital.
Objectives of the EID
• To provide services for EID so as to guide early
interventions for HIV exposed and infected infants
• To assess and improve the PMTCT program
EID/DBS process
Sample
Collected at
Health
Facility
Results
Returned to
Caregiver
1
Sample
Dispatched
from Facility
2
Sample
Received by
Lab
3
4
Results
Processed and
Packed in Lab
7
Results
Dropped at
Health Facility
6
Results
Picked up
for
Transport
5
4
Coverage of the service in Karamoja
• 130 Health workers have been trained in EID.
• Each district has at least one health facility providing
EID services
• 261 Exposed babies (6 weeks – 18 months) have been
tested for HIV through DBS (Jan – Sept 2009)
• 43 (16%) babies have tested HIV positive.
DBS performance by district
450
408
400
350
300
261
250
200
150
99
100
50
130
120
90
89
51
62
61
32
15
11
6
61
19
22
4
0
Abim
Moroto
Health workers trained
Kotido
38
23
Nakapiripirit
Mothers tested HIV +ve
10
43
26
3
Kaabong
DBS collected
Total
DBS tested positive
Key Issues
ss:Identification
Not capturing
exposed
infants
& testing
exposed
infant.
•Healthcare workers not proactively identifying and
referring exposed infants.
• Exposed infants referred from different wards/clinics for
on-site DBS testing are not reaching the testing point.
• HIV+ pregnant women identified at ANC or maternity not
bringing infants for DBS testing at 6 weeks.
• Inefficient referral system for EID testing from lower-level
health centers not trained in EID.
7
Key Issues.
Provision of results
•Caregivers unclear when/where to return for results.
• Poor appointment system to trigger follow-up.
•Inadequate care provision undermines importance of
infants returning regularly.
• Long sample and result turnaround times.
8
Way forward.
• Improve follow-up and linkage of the tested babies
to care and treatment.
• Improve turnaround time of DBS results.
– Coordination and monitoring of ANC/PMTCT sites, testing
labs, and sample/results transportation.
– Coordinated training and sample transportation (use of
Kaabong for Northern Karamoja & Moroto for Southern
Karamoja).
– Use of the courier system (future plan).
Way forward cont;
• Integrate EID in routine services
• Child health days .
• Routine immunization outreaches.
• Nutritional screening and treatment centre's.
• Improving clinic-level systems to ensure that each infant makes it
successfully from one point to the other.
• Establishing a single follow-up point at each facility especially at HSD
and hospitals.
• Strengthening provision of routine care in EID services & visvasa.
• Creating referral systems within the facility.
Thank you for listening
Complexity of EID & points to lose exposed infants
1
2
Identify and test
exposed infant
• Exposed infants
must be identified
from multiple
‘entry points’
within the health
facility &
successfully
referred for DBS
testing
Provide results to
caregiver & guide
through test algorithm
• Samples transported
to JCRC
• Results transported
back to health facility
and appropriate HCW’s
3
Enroll
positives
in ART Clinic
• Positive infants
must be
successfully
referred to on- or
off-site ART clinic
4
Retain alive
in care/
treatment
• Enrolled infants
must be retained at
ART clinic through
requisite counseling
and high quality
care/treatment
•Caregivers must
return to get results
•Infants must return
for any follow-up visits
Given the rapid disease progression of HIV in infants, basic care and
prophylaxis must be provided to infants throughout the EID process
12