HIV-exposed infant follow-up in Mozambique: formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation.

Publication Date:

Mar 2020

Citation:

Vieira L, Miloque M, Napua M, Chale F, Manuel JL, Cowan JG, et al. (2020). HIV-exposed infant follow-up in Mozambique: formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation. BMC Health Serv Res. 20(226). doi: 10.1186/s12913-020-5051-8

Abstract

Background
Early infant diagnosis (EID) of HIV-exposed and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor.

Methods
The research was conducted in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of clinic waiting times, and 3) patient and health worker focus groups.

Results
HIV testing and ART initiation coverage for mothers tends to be high, but EID and pediatric ART initiation are hampered by lack of patient tracking, long waiting times, and inadequate counseling to navigate the care cascade. About 76% of HIV-positive infants were LTFU and did not initiate ART.

Conclusions
Effective interventions to reduce LTFU in EID and improve pediatric ART initiation should focus on patient tracking, active follow-up of defaulting patients, reduction in EID turn-around times for PCR results, and initiation of ART by nurses in child-at-risk services.

Read the Full Article

Stand with HAI

Stand with HAI

Donate

When you support Health Alliance International, you take a stand for a more equitable and respectful model of global health. Your donation not only helps us expand our reach, it is an investment in our shared values of health equity and solidarity. 

Join the Alliance

Our alliance is made up of supporters, partners, staff, and volunteers who share our commitment to universal access to quality health care. Just like a health system, every person plays a role in keeping us working toward this ultimate goal. Will you join us? 

Get Engaged

The kind of change we seek requires sustained action.  Whether you want to engage in HAI's advocacy work or help spread HAI's mission and model, we rely on our friends and supporters to stand beside us when we stand up for equity in global health.

Didn't find what you were looking for?

Didn't find what you were looking for?