title: Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi.
abstract: OBJECTIVE
  Malawi's national guidelines recommend that infants exposed to the human immunodeficiency virus (HIV) be tested at 6 weeks of age. Rollout of services for early infant diagnosis has been limited and has resulted in the initiation of antiretroviral therapy (ART) in very few infants.
  
  
  METHODS
  An early infant diagnosis programme was launched. It included education of pregnant women on infant testing, community sensitization, free infant testing at 6 weeks of age, active tracing of HIV-positive infants and referral for treatment and care.
  
  
  METHODS
  The programme was established in two primary care facilities in Blantyre, Malawi.
  
  
  RESULTS
  Of 1214 HIV-exposed infants, 71.6% presented for early diagnosis, and 14.5% of those who presented tested positive for HIV. Further testing of 103 of these 126 apparently HIV-positive infants confirmed infection in 88; the other 15 results were false positives. The initial polymerase chain reaction testing of dried blood spots had a positive predictive value (PPV) of 85.4%. Despite active tracing, only 87.3% (110/126) of the mothers of infants who initially tested positive were told their infants' test results. ART was initiated in 58% of the infants with confirmed HIV infection.
  
  
  CONCLUSIONS
  Early infant diagnosis of HIV infection at the primary care level in a resource-poor setting is challenging. Many children in the HIV diagnosis and treatment programme were lost to follow-up at various stages. Diagnostic tools with higher PPV and point-of-care capacity and better infrastructures for administering ART are needed to improve the management of HIV-exposed and HIV-infected infants.
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: Queen
authors.initials: Q
authors.lastname: Dube
authors.forename: Anna
authors.initials: A
authors.lastname: Dow
authors.forename: Chawanangwa
authors.initials: C
authors.lastname: Chirambo
authors.forename: Jill
authors.initials: J
authors.lastname: Lebov
authors.forename: Lyson
authors.initials: L
authors.lastname: Tenthani
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heyderman
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods*; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008295:Malawi; D008297:Male; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011247:Pregnancy; D011320:Primary Health Care / Q000379:methods*; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents