title: Provision of services and care for HIV-exposed infants: a comparison of maternal and child health clinic and HIV comprehensive care clinic models.
abstract: OBJECTIVE
  Prevention of Mother-to-Child Transmission of HIV programs require follow-up of HIV-exposed infants (HEI) for infant feeding support, prophylactic medicines, and HIV diagnosis for at least 18 months. Retention in care and receipt of HIV services are challenging in resource-limited settings. This study compared infant follow-up results when HEI services were provided within Maternal and Child Health (MCH) clinics or in specialized HIV Comprehensive Care Clinics (CCCs) in Kenya.
  
  
  METHODS
  This observational prospective cohort study enrolled HEI at 6-8 weeks of age in 2 purposively selected hospitals with similar characteristics but different models of service delivery. In the CCC model, HEI received immunization and growth monitoring in MCH but cotrimoxazole prophylaxis and infant HIV testing in the CCC. In the MCH model, all services were provided in the MCH. Data were collected at enrollment, 14 weeks, and 6, 9, and 12 months.
  
  
  RESULTS
  From April 2008 to April 2009, 184 HEI were enrolled in the CCC cohort and 179 in the MCH cohort. Infants in MCH were 1.14, 1.42, 1.95, and 1.29 times more likely to attend 14-week, 6-, 9-, and 12-month postnatal visits, respectively, and 2.24 times (95% confidence interval: 1.57 to 3.18) more likely to attend all 4 visits. Although infants in MCH were 1.33 times (95% confidence interval: 1.10 to 1.62) more likely to have HIV antibody testing at 1 year than CCC, there were no differences for polymerase chain reaction test or cotrimoxazole initiation at 6-8 weeks.
  
  
  CONCLUSIONS
  HIV services integrated in MCH yield better follow-up of HEI than CCC.
authors.affiliation: Department of Obstetrics and Gynaecology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya. jongech@pedaids.org
authors.forename: John Odero
authors.initials: JO
authors.lastname: Ongʼech
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Hoffman
authors.forename: Judith
authors.initials: J
authors.lastname: Kose
authors.forename: Michael
authors.initials: M
authors.lastname: Audo
authors.forename: Lucy
authors.initials: L
authors.lastname: Matu
authors.forename: Peter
authors.initials: P
authors.lastname: Savosnick
authors.forename: Laura
authors.initials: L
authors.lastname: Guay
mesh_terms: D000328:Adult; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008297:Male; D008430:Maternal-Child Health Centers / Q000458:organization & administration*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000517:prevention & control*; D011446:Prospective Studies