February 21, 2014
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, firstname.lastname@example.org, +267 367-2400).
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
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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