Strategies for linking HIV exposed infants to HIV care services at South Lunzu health centre by Rhoda Salome Kunje
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Date
12-05-21
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Kamuzu University of Health Sciences
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
retaintion rate and 9.6% was the default rate.At 24 months 176 infants were enrolled and there was
57.4% retaintion 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 quantintative 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).Abstrction
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 therafter 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.