Introducing a Multi-Site Program for Early Diagnosis of HIV Infection among HIV-Exposed Infants in Tanzania

This article discusses 2006 - 2007 research on a pilot early infant diagnosis (EID) programme in the Lake region of Tanzania aiming to establish laboratory capacity and infrastructure to perform HIV DNA Polymerase Chain Reaction (PCR) testing, including communication aspects of reaching families for testing. In Tanzania, less than a third of HIV-infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In September 2006, a molecular biology laboratory at Bugando Medical Center was established in order to perform this testing. Ninety- six health workers from 4 health facilities were trained in the identification and care of HIV-exposed infants, HIV testing algorithms, and collection of dried blood samples.

Community preparation was done in order to increase the number of infants and children tested and ensure that their parents/guardians returned to receive results and therapy.

Communication-related community preparation included:

-Engaged communities before services were introduced.
-Focused on influential community leaders for community advocacy.
-Utilised community gatherings for mass communication.

Outcomes observed include:

-Created anticipation for the services.
-Community members encouraged to access services.
-Quickly informed many community members.

Challenges encountered include:

-Community members expected same-day test results and not to have to return for results at a later visit.

In addition, training was provided for health facility staff, who also participated in the creation of a practical plan on how services would be offered. To prepare health workers for service implementation, training and complementary on-site mentoring was provided, and there was supervision during the early phases of implementation.

Healthcare facilities were chosen based on geography, demographics, and services. The selected health facilities had antenatal care clinics with well-established prevention of mother-to-child HIV transmission (PMTCT) programmes.

In order to ensure follow-up, communications systems were established with parents. Each parent or guardian received a follow-up appointment 1 month after testing to receive DNR PCR results and to refill cotrimoxazole prescriptions. If parents/guardians did not return to the clinic within 28 days of the scheduled appointment, contact tracing by phone and home visits was done by ICAP staff and health facility EID nurses in collaboration with community outreach groups. Due to the limited resources, staff prioritised visits to children testing PCR positive.

Statistics are presented on the rate of exposure, infection, and follow up. One of the biggest challenges noted is that only 55% of the parents/guardians returned for PCR test results which is critical to preventing mortality. The study notes that "program success depends on good systems to identify, follow and retain all children in care. Additional research is needed to understand the reasons that prevent parents and guardians from returning for results and to determine optimal ways to continue to engage these families in HIV services."