title: Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in Lilongwe, Malawi.
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).
  
  
  METHODS
  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.
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Maureen
authors.initials: M
authors.lastname: Braun
authors.forename: Mark M
authors.initials: MM
authors.lastname: Kabue
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.forename: Maria
authors.initials: M
authors.lastname: Kim
authors.forename: Leela
authors.initials: L
authors.lastname: Aertker
authors.forename: Marko
authors.initials: M
authors.lastname: Chirwa
authors.forename: Michael
authors.initials: M
authors.lastname: Eliya
authors.forename: Innocent
authors.initials: I
authors.lastname: Mofolo
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kline
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002662:Child Health Services; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D042241:Early Diagnosis; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1 / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006287:Health Planning Guidelines; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008295:Malawi; D008297:Male; D008427:Maternal Health Services; D016133:Polymerase Chain Reaction / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies
chemical_list: D015483:HIV Antibodies