Strategies for linking HIV exposed infants to HIV care services at South Lunzu health centre
| dc.contributor.author | Kunje, Rhoda Salome | |
| dc.date.accessioned | 2021-11-26T12:03:31Z | |
| dc.date.available | 2021-11-26T12:03:31Z | |
| dc.date.issued | 2021-05-12 | |
| dc.description.abstract | Background: HIV exposed infant care in Malawi is integrated with maternal ART follow-up to improve retention. Malawi National HIV Testing and Counselling (HTC) guide lines for HIV –exposed infants recommend a DNA PCR test done at 6 weeks, followed by 2 confirmatory rapid tests at 12 and 24 months to determine the HIV status of HIV exposed infants. Infants also receive 6 weeks of Nevirapine(NVP) starting at birth and early infant HIV DNA polymerase chain Reaction(PCR) diagnosis using dried blood spots after 6 weeks of age are done, Infants are clinically followed up until determination of final HIV infection status(1). Despite efforts to improve retention, lost to follow-up remains a challenge in the care of HIV exposed infants. Astudy done by Wingston F. Ng’ambi and others in Lilongwe Malawi showed that overall 48% of HIV-exposed infants were declared lost to follow-up due to a number of reasons (2). Available data at South Lunzu health facility in Blantyre Malawi, demonstrates that from 2018 to 2020, there has been increased numbers of children who have defaulted from HIV care services especially at 12 months and 24 months after being initiated in care. In 2018, out of the 213 HIV exposed infants that were enrolled at 2 months,96.6% were retained in care and 2.4% was the default rate. At 12 months 190 infants were enrolled in care and 70.4% was the retention rate and 9.6% was the default rate. At 24 months 176 infants were enrolled and there was 57.4% retention rate and 42.6% default rate. In 2019, 175 HIV exposed infants were enrolled and retention rate was at 97.6% and default rate was at 2.4%. At 12 months 162 HIV exposed infants were enrolled, 81.8% was the retention rate and 18.2% was the default rate. At 24 months, 146 infants were enrolled and retention rate was 61.1% and 38.4% was the default rate. This trend of defaulting from HIV care continued for the year 2020 especially as the children grew older. For this study, the researcher expects to find that there are no strategies or interventions at the health facility that are put in place to link back the HIV exposed infants who are lost to follow up for HIV health care services despite the increased default rates. Problem statement: Early Infant Diagnosis (EID) of HIV infection at the primary care level in Malawi is challenging. Many children are indeed tested for HIV and some are found to be HIV infected while others are HIV uninfected in the HIV diagnosis and treatment program and they are lost to follow-up at various stages. In Malawi’s option B+, loss to follow-up remains a great challenge in the care of HIV exposed infants, and although the Malawi government recommends HIV exposed infants receive Early Infant Diagnosis(EID) at under-five Paediatric clinics, most of these children are never enrolled. In 2014, less than 20% of HIV-exposed infants received early infant diagnosis test in the first 2 months of life, and only 30% of the HIV infected children were on antiretroviral therapy (13). Those children who are lost to follow are at higher risk of infection and opportunities to enter them into care are rare, consequently these children do not come back, if they come at all, its until they develop serious AIDS- defining illnesses, leading to death. OBJECTIVES: The aim of the study is to explore strategies for linking HIV- exposed infants who are lost to follow-up back into HIV care services at South Lunzu Health Centre in Blantyre,Malawi.Specifically, the study seeks to determine the proportion of HIV-exposed babies who tested positive to HIV and were lost to follow-up in relation to HIV care services,to describe the views of Health Care workers on effectiveness of the interventions currently in place for linking HIV exposed infants to HIV care services and to establish the remedies suggested by postpartum/breastfeeding mothers who are infected with HIV on minimizing lost to follow up cases amongst HIV positive infants at South Lunzu Health Centre. Methodology: The research is a cross-sectional study using mixed methods (quantitative and qualitative) where data will be collected at the same time or approximately the same time period. Questionnaires and Focus Group Discussions will be used to collect the data at the same time period. The population of interest for this study will include ;HIV positive mothers who have exposed their infants to HIV but are lost to follow-up to HIV services and care, HIV exposed infants, and the health Care Workers at South Lunzu health facility (Nurse midwives, Health Surveillance Assistants, Clinicians, Expert clients).The sample size for the quantitative method will be 384 and participants will be randomly sampled from health records at the facility. The sample size for the qualitative method will be approximately 30, and participants will be purposefully selected. Data collection for the qualitative method will be done right at the health facility in quiet and private rooms through focus group discussions(FGDs). Abstraction sheet will be used to abstract data from health records. Data collected from participants will be securely stored in a computer data base that has a password and limited access will be provided to the study team. Data analysis will be done using deductive thematic content analysis. Informed consent will be obtained from each participant before being enrolled in the study. Confidentiality throughout study participation and thereafter will be ensured. Ethical approval will be sought from College of Medicine and Ethics Committee(COMREC). Dissemination of expected findings: The results of this study shall be disseminated in writing and presentations as feedback will be made to the: College of Medicine Research Ethics Committee(COMREC), investigators and study team, College of Medicine library, The University Research and Publication Committee(URPC)through the COMREC secretariat, All health workers at South Lunzu Health Centre, District Health Management Team (DHMT)for Blantyre including the Blantyre District PMTCT/EID Technical Working Group and to the wider scientific community through the COM Research and Dissemination Conference and preparation of a manuscript for submission to a peer-review journal. | en_US |
| dc.description.sponsorship | Kamuzu University of Health Sciences | en_US |
| dc.identifier.uri | http://rscarchive.kuhes.ac.mw/handle/20.500.12988/560 | |
| dc.language.iso | en | en_US |
| dc.publisher | Kamuzu University of Health Sciences | en_US |
| dc.relation.ispartofseries | Ethics Protocol;P.02/21/3259 | |
| dc.title | Strategies for linking HIV exposed infants to HIV care services at South Lunzu health centre | en_US |
| dc.type | Plan or blueprint | en_US |