Inadequate Coordination of Maternal and Infant HIV Services Detrimentally Affects Early Infant Diagnosis Outcomes in Lilongwe, Malawi
Open accessAbstract
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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In practice, HIV transmission rates are several times higher than trial rates because of high drop-out rates of HIV-positive women along the PMTCT care cascade.
“the rates are several times higher in practice because of the high drop-out rates of HIV-positive women along the PMTCT care cascade [1-3,6-9].”
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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
- ORCID
- Venue
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Published
- 2011-04-15
- Volume
- 56
- Issue
- 5
- Pages
- e122-e128
- ISSN
- 1525-4135 (ISSN-L)
- PMC
- PMC3112277
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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