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Uganda’s new approach to improve testing, retention & care of HIV-exposed infants

Uganda’s new approach to improve testing, retention & care of HIV-exposed infants. Kiyaga Charles Ministry of Health Uganda 23 July 2010 ckiyaga@yahoo.com. Background.

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Uganda’s new approach to improve testing, retention & care of HIV-exposed infants

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  1. Uganda’s new approach to improve testing, retention & care of HIV-exposed infants Kiyaga Charles Ministry of Health Uganda 23 July 2010 ckiyaga@yahoo.com

  2. Background • The national EID program in Uganda has rapidly scaled up since its start in 2007, providing services at 550 sites and testing over 50,000 infants by the end of 2009. • Despite rapid scale-up, comprehensive review of EID services in 2009 showed that infants were being lost throughout the EID process: Infant Retention Cascade at 3 Regional Referral Hospitals Sept 2007 – Feb 2009 39% of positive infants never received results 35% of positive infants receiving results were never enrolled into care 42% of positive infants in care & treatment were lost

  3. In response to identified challenges, MOH developed a package of 6 complementary “strengthening” interventions

  4. EID “strengthening” interventions were piloted by MOH at 21 sites in 8 districts The objectives of the strengthening pilot were; • To increase the number of HIV-exposed infants accessing PCR testing • To increased the percentage of tested infants receiving results AND either • Completing the infant testing algorithm (if negative), or • Accessing care and treatment at the ART clinic (if positive) • To improve the quality of care provided to HIV-exposed infants by shifting EID services from the lab to a clinic-based program with sufficient staff & basic resources Since the pilot, EID Strengthening interventions have been scaled up by IPs to 64 sites across 25 districts

  5. EID strengthening rollout package has 5 key components (Method) 1 2 3 4 5

  6. This pilot was assessed in 4 health facilities as a mini-assessment. It has demonstrated that, identification and testing of exposed infants can be extended to earlier stages in the EID process… NOT actively referring before pilot Exposed infants now being identified and referred before & at birth— likely that many wouldn’t have accessed health system again All departments are actively referring— can be attributed to increased focus on EID and sensitization of HCWs throughout the facility

  7. PCR testing volumes have increased by over 40% since implementation of the EID strengthening pilot Avg Monthly Testing Volumes Pre- and Post-Training 4 health centers Number of DBS Tests 4 Health Centers (Aggregate) Sep 2009 – April 2010 Trainings Post-Training Pre-Training

  8. Exposed infants are now being tested at a much younger age Average Age at 1st PCR Test (months) Pre- and Post-Implementation 2 Health Centers n = 134 n = 139 n = 31 n = 35

  9. Provision of Cotrimoxazole has increased every month since implementation, and infants are clinically assessed at every visit % of exposed infants initiated on CTX Post-Implementation 4 Health Centers • Regular and increasing levels of cotrim provision at pilot sites can be attributed to: • Creation of “EID care point” & improved clinic flow with centralization of care • HCWs trained and sensitized on the use/ important of CTX for exposed infants • HCWs required to document CTX provision on Register and Clinical Chart • Care assessments now done at every visit: • Clinical assessment • Growth monitoring (weight, height) • Head circumference • Developmental milestones

  10. 69% of the tested infants have received results, and 97% of HIV+ infants receiving results have enrolled at an ART clinic Percent of Caregivers receiving results Pre- and Post-Implementation 4 Health Centers Linkage of HIV-Positive Infants to ART Pre- and Post- Implementation 4 Health Centers n = 209 n = 305 n = 8 n = 29

  11. Challenges persist, but EID strengthening approach has demonstrated high impact & shown feasibility of implementation Ever Present Challenges The EID strengthening pilot has shown the value and feasibility of changing EID from merely a testing service to a longitudinal comprehensive care package for all HIV-exposed infants • Increased workload for health workers and human resource constraints • Inefficient/inconsistent sample-result transport network delays return of results • Occasional stock-outs of rapid test kits hindering identification of HIV-exposed infants for DBS testing • Increased cost of Strengthening Program compared to previous implementation model

  12. Acknowledgements Co-authors:Vijay Narayan, Ian McConnell,Peter Elyanu, Cordelia Katureebe, Adeodata Kekitiinwa, Sangeeta Tripathi and Zainab Akol The Ministry of Health would like to thank two key partners for their support in making this pilot a resounding success: 1) The Clinton Health Access Initiative (CHAI) has supported the Ministry in the development of the strengthening approach, and provides all the supplies and reagents for EID. The Ministry is extremely grateful for the technical and logistical support by CHAI. 2) Joint Clinical Research Centre has been an indispensible partner. JCRC analyzes and tests almost all DBS samples in Uganda, which makes provision of EID services possible.

  13. Questions?

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