title: Follow-up and programmatic outcomes of HIV-exposed infants registered in a large HIV centre in Lilongwe, Malawi: 2012-2014.
abstract: OBJECTIVE
  To assess follow-up and programmatic outcomes of HIV-exposed infants at Martin Preuss Centre, Lilongwe, from 2012 to 2014.
  
  
  METHODS
  Retrospective cohort study using routinely collected HIV-exposed infant data. Data were analysed using frequencies and percentages in Stata v.13.
  
  
  RESULTS
  Of 1035 HIV-exposed infants registered 2012-2014, 79% were available to be tested for HIV and 76% were HIV-tested either with DNA-PCR or rapid HIV test serology by 24 months of age. Sixty-five infants were found to be HIV-positive and 43% were started on antiretroviral therapy (ART) at different ages from 6 weeks to 24 months. Overall, 48% of HIV-exposed infants were declared lost-to-follow-up in the database. Of these, 69% were listed for tracing; of these, 78% were confirmed as lost-to-follow-up through patient charts; of these, 51% were traced; and of these, 62% were truly not in care, the remainder being wrongly classified. Commonest reasons for being truly not in care were mother/guardian unavailability to bring infants to Martin Preuss Centre, forgetting clinic appointments and transport expenses. Of these 86 patients, 36% were successfully brought back to care and 64% remained lost-to-follow-up.
  
  
  CONCLUSIONS
  Loss to follow-up remains a huge challenge in the care of HIV-exposed infants. Active tracing facilitates the return of some of these infants to care. However, programmatic data documentation must be urgently improved to better follow-up and link HIV-positive children to ART.
authors.affiliation: The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Wingston F
authors.initials: WF
authors.lastname: Ng'ambi
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.|National Tuberculosis Programme, Cotonou, Benin.
authors.forename: Serge
authors.initials: S
authors.lastname: Ade
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: HIV Department, Ministry of Health, Lilongwe, Malawi.
authors.forename: Dalitso
authors.initials: D
authors.lastname: Midiani
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: Philip
authors.initials: P
authors.lastname: Owiti
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.|AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Kudakwashe C
authors.initials: KC
authors.lastname: Takarinda
authors.affiliation: The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.|International Training and Education Center for Health, Seattle, WA, USA.
authors.forename: Salem
authors.initials: S
authors.lastname: Gugsa
authors.affiliation: The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
keywords: 
  HIV
  ; 
  VIH
  ; HIV-exposed children; Malawi; antiretroviral therapy; back-to-care programme; enfants exposés au VIH; niños expuestos al VIH; programa back-to-care; programme de retour aux soins; terapia antirretroviral; traitement antirétroviral