Cited by 91HIV/AIDS Research and InterventionsGlobal Maternal and Child HealthHIV/AIDS drug development and treatment

Inadequate Coordination of Maternal and Infant HIV Services Detrimentally Affects Early Infant Diagnosis Outcomes in Lilongwe, Malawi

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Braun, Maureen, Kabue, Mark M, McCollum, Eric D, Ahmed, Saeed, Kim, Maria, Aertker, Leela, Chirwa, Marko, Eliya, Michael +6 more·2011·JAIDS Journal of Acquired Immune Deficiency Syndromes

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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  1. [9]Malawi Ministry of Health. Department of HIV and AIDS Quarterly report of the Antiretroviral Treatment Programme in Malawi with results up to March 2010 Department of HIV and AIDS MoH Lilongwe 2010
  2. [31]Nadim Mahmud Joce Rodriguez Nesbit Josh 2010 Mobiles in Malawi: A text message-based intervention to bridge the patient-physician gap in the rural developing world The American Medical student Association's International Health Journal 6 1 Available at: http://www.globalpulsejournal.com
  3. [35]Ahmed S Kim Maria Kanjelo Kondwani Nanthuru Debora Taimu Thomas Ndovie Lughano Mwasabi Innocent Msiska Damson Bowa Elson Kazembe Peter Kline Mark Using Community Health Workers to Improve Identification, Enrollment Into Care, and Outcomes for HIV-Exposed Infants at the Kawale Health Centre in Lilongwe, Malawi Abstract WEPE0842 AIDS 2010 Conference
  4. [36]Ahmed S Kim M Kanjelo K Taimu T Kabue M Kazembe P Kline M Using Community Health Workers to Improve Identification and Early Referral to Care of HIV-Infected Children Abstract TUPED090 International AIDS Society Conference, Cape Town 2009
  5. [42]World Health Organization Rapid Advice: Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants Geneva WHO 2009 26180894

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Authors
Braun, M., Kabue, M. M., McCollum, E. D., Ahmed, S., Kim, M., Aertker, L., Chirwa, M., Eliya, M., Mofolo, I., Hoffman, I., Kazembe, P. N., van der Horst, C., Kline, M. W., & Hosseinipour, M. C.
Affiliations
  • Pennsylvania State University (US)
  • Ministry of Health (MW)
  • University of North Carolina at Chapel Hill (US)
  • Baylor College of Medicine (US)
Corresponding author
  • Braun, Maureen
  • McCollum, Eric D
  • Aertker, Leela
  • Chirwa, Marko
  • Mofolo, Innocent
  • Hosseinipour, Mina C
Venue
JAIDS Journal of Acquired Immune Deficiency Syndromes
Published
2011-04-15
Volume
56
Issue
5
Pages
e122-e128
ISSN
1525-4135 (ISSN-L)
OpenAlex
W1994528984
Cited by
91
References
27
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 7 · 2016: 10 · 2015: 10 · 2014: 10 · 2013: 16 · 2012: 13
FWCI
9.10
Type
journal article
Language
en
Open access
Locations
  • JAIDS Journal of Acquired Immune Deficiency Syndromes (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (T32HL072748)
  • National Institute of Allergy and Infectious Diseases (P30 AI50410, P30AI050410)
  • Fogarty International Center (D43TW001039, R24TW007988, D43-TW01036, D43TW001036)
  • National Center for Chronic Disease Prevention and Health Promotion (U48-DP-001944, 1U48DP001944)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Keywords
infant HIV testing, early infant HIV diagnosis, continuity of care, service coordination, prevention of mother-to-child transmission, pediatric HIV treatment, antiretroviral therapy initiation, infant survival, HIV-exposed infants, HIV-infected infants, attrition, patient retention, Lilongwe, Malawi
MeSH terms
Child Health Services, Female, Health Planning Guidelines, Humans, Infant, Infant Mortality, Malawi, Male, Maternal Health Services, Pregnancy, Pregnancy Complications, Infectious, Retrospective Studies, Cohort Studies, HIV Antibodies, AIDS Serodiagnosis, HIV-1, HIV Infections, Polymerase Chain Reaction, Infectious Disease Transmission, Vertical, Delivery of Health Care, Integrated, Antiretroviral Therapy, Highly Active, Early Diagnosis

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