title: Superior uptake and outcomes of early infant diagnosis of HIV services at an immunization clinic versus an "under-five" general pediatric clinic in Malawi.
abstract: OBJECTIVE
  Although the Malawian government recommends HIV-exposed infants receive early infant diagnosis (EID) of HIV at "under-five" pediatric clinics (U5Cs), most never enroll. Therefore, we evaluated the integration of EID testing into an immunization clinic (IC) compared with the current standard of EID testing at an U5C.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Using routine provider-initiated HIV testing and counseling (PITC) registers, we prospectively studied 1757 children offered PITC at a government IC and U5C. Infants tested by HIV DNA polymerase chain reaction (PCR) were followed until PCR result disclosure or defaulting.
  
  
  RESULTS
  We sampled 877 and 880 consecutive PITC recipients at U5C and IC, respectively. Overall, a 7-fold greater proportion received PITC at IC (84.2% vs. 11.4%, P < 0.001). PITC recipients at IC were more than 14 months younger (2.6 vs. 17.0, P < 0.001), with greater proportions HIV exposed (17.6% vs. 5.3%, P < 0.001) and PCR eligible (7.9% vs. 3.5%, P < 0.001). A higher percentage of IC infants accepted PCR testing (100.0% vs. 90.3%, P = 0.03). Additionally, IC PCR recipients were 2.5 months younger (3.1 vs. 5.6, P < 0.001) with 4 times less testing PCR positive (7.1% vs. 32.1%, P < 0.001). Importantly, a more than 3-fold greater proportion of HIV-exposed infants at IC returned for their PCR result and enrolled into care (78.6% vs. 25.0%, P < 0.001).
  
  
  CONCLUSIONS
  Compared with an U5C, integrating EID testing into an IC is more acceptable, more feasible, enrolls more infants into EID at younger ages, and would likely strengthen Malawi's EID services if expanded.
authors.affiliation: Department of Pediatrics, Kamuzu Central Hospital, University of North Carolina Project, Lilongwe, Malawi. ericdmccollum@gmail.com
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
authors.forename: Derek C
authors.initials: DC
authors.lastname: Johnson
authors.forename: Charles S
authors.initials: CS
authors.lastname: Chasela
authors.forename: Linias D
authors.initials: LD
authors.lastname: Siwande
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.forename: Dan
authors.initials: D
authors.lastname: Olson
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002675:Child, Preschool; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006678:HIV / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
chemical_list: D004279:DNA, Viral