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Follow-Up of Infants Diagnosed With HIV -- Early Infant Diagnosis Program, Francistown, Botswana, 2005-2012

February 21, 2014

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Acknowledgments

E. Dintwa, K. Keapoletswe, Botswana Ministry of Health and the Francistown District Health Management Team.

Catherine Motswere-Chirwa, P.D.M., Andrew Voetsch, Ph.D., Lydia Lu, M.P.H., Phenyo Lekone, Ph.D., Esther Machakaire, M.D., Keitumetse Legwaila, Stembile Matambo, Maruping Maruping, Thatayotlhe Kolobe, Mary Glenshaw, Ph.D., Helen Dale, B.V.Sc., M.B.Ch.B., Margarett Davis, M.D., Andrew Pelletier, M.D., Division of Global HIV/AIDS, Center for Global Health, CDC; Victor Letsholathebe, Chipo Petlo, Refeletswe Lebelonyane, M.D., Shenaaz El Halabi, M.P.H., Botswana Ministry of Health (Corresponding author: Catherine Motswere-Chirwa, hoc0@cdc.gov, +267 367-2400).


References

  1. Creek T, Tanuri A, Smith M, et al. Early diagnosis of human immunodeficiency virus in infants using polymerase chain reaction on dried blood spots in Botswana's national program for prevention of mother-to-child transmission. Pediatr Infect Dis J 2008;27:22-6.
  2. Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008;359:2233-44.
  3. Becquet R, Marston M, Dabis F, et al. Children who acquire HIV infection perinatally are at higher risk of early death than those acquiring infection through breastmilk: a meta-analysis. PloS One 2012;7:e28510.
  4. Boender TS, Sigaloff KC, Kayiwa J, et al. Barriers to initiation of pediatric HIV treatment in Uganda: a mixed-method study. AIDS Res Treat 2012;817506.
  5. Ciaranello AL, Park JE, Ramirez-Avila L, Freedberg KA, Walensky RP, Leroy V. Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions. BMC Med 2011;9:59.
  6. Chiduo MG, Mmbando BP, Theilgaard ZP, et al. Early infant diagnosis of HIV in three regions in Tanzania; successes and challenges. BMC Public Health 2013;13:910.
  7. Lilian RR, Kalk E, Technau KG, Sherman GG. Birth diagnosis of HIV infection in infants to reduce infant mortality and monitor for elimination of mother-to-child transmission. Pediatr Infect Dis J 2013;32:1080-5.
  8. Seidenberg P, Nicholson S, Schaefer M, et al. Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results. Bull World Health Organ 2012;90:348-56.
  9. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach 2013. Geneva, Switzerland: World Health Organization; 2013.


What is already known on this topic?

Despite high rates of human immunodeficiency virus (HIV) testing and antiretroviral prophylaxis for HIV-infected pregnant women in Botswana, up to 4% of their infants are born HIV-infected. Without antiretroviral therapy (ART), half of HIV-infected infants will die in the first year of life. Delays in HIV screening, return of test results, referral, and initiation of ART, and loss to follow-up increase infant mortality.

What is added by this report?

The Botswana Early Infant Diagnosis (EID) Program was introduced in 2005 to screen infants for HIV beginning at age 6 weeks. In Francistown, Botswana, during 2005-2012, 71% of infants born to HIV-infected women were screened for HIV. As of September 2013, among the 202 HIV-infected infants identified by the EID program, 41% were alive and on ART, 39% had died, and 20% were lost to follow-up, had transferred, or the family had declined therapy.

What are the implications for public health practice?

Even in a successful program to prevent mother-to-child transmission, survival of HIV-infected infants is poor without early diagnosis, rapid initiation of treatment, and retention in care. Strategies to overcome educational, cultural, and structural barriers are needed to improve patient outcomes in the EID program.


FIGURE. Percentage of Infants Diagnosed With HIV (N = 202*) Whose Mothers Received Post-HIV Test Counseling, Percentage Who Received ART, and Percentage Who Were Alive and on ART Through September 2013 -- Early Infant Diagnosis Program, Francistown, Botswana, 2005-2012

Percentage of Infants Diagnosed With HIV (N = 202*) Whose Mothers Received Post-HIV Test Counseling, Percentage Who Received ART, and Percentage Who Were Alive and on ART Through September 2013 -- Early Infant Diagnosis Program, Francistown, Botswana, 2005-2012

Abbreviations: HIV = human immunodeficiency virus; ART = antiretroviral therapy.

* A total of 10,923 infants in the program were exposed to HIV (i.e., born to HIV-infected mothers); 7,772 were tested for HIV infection, and 202 were diagnosed with HIV infection.

Alternate Text: The figure above shows the percentage of infants diagnosed with HIV infection (N = 202) whose mothers received post-HIV test counseling, percentage who received antiretroviral therapy (ART), and percentage who were alive and on ART through September 2013 in Francistown, Botswana during 2005-2012. The Botswana Prevention of Mother-to-Child Transmission Program identified a total of 10,923 HIV-exposed infants. Of these, 7,772 (71%) were tested for HIV, and 202 (2.6%) were diagnosed with HIV infection. Of the 202 HIV-infected infants, the mothers of 153 (75%) had post-HIV test counseling, 123 (60%) infants received ART, and through September 2013, 82 (41%) were alive and on ART.

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This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication Morbidity and Mortality Weekly Report. Visit the CDC's website to find out more about their activities, publications and services.
 

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