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Scaling up Early Infant HIV Diagnosis (EID) in Karamoja. Health Nutrition HIV coordination meeting 9 th December 2009. Background . Over 2 years since the testing of HIV among exposed infants started in Uganda; over 1 year in Karamoja region.
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Scaling up Early Infant HIV Diagnosis (EID) in Karamoja Health Nutrition HIV coordination meeting 9th December 2009
Background • Over 2 years since the testing of HIV among exposed infants started in Uganda; over 1 year in Karamoja region. • EID program enables testing of infants as early as 6 weeks. • Currently there are 8 labs with DNA PCR technology in the different regions of the country. • Karamoja is served by JCRC Mbale referral hospital.
Objectives of the EID • To provide services for EID so as to guide early interventions for HIV exposed and infected infants • To assess and improve the PMTCT program
EID/DBS process Sample Dispatched from Facility Sample Received by Lab Sample Collected at Health Facility 1 2 3 4 5 6 7 Results Processed and Packed in Lab Results Returned to Caregiver Results Picked up for Transport Results Dropped at Health Facility
Coverage of the service in Karamoja • 130Health workers have been trained in EID. • Each district has at least one health facility providing EID services • 261Exposed babies (6 weeks – 18 months) have been tested for HIV through DBS (Jan – Sept 2009) • 43 (16%) babies have tested HIV positive.
Key Issues • ss: Not capturing exposed infants • Identification & testing exposed infant. • Healthcare workers not proactively identifying and referring exposed infants. • Exposed infants referred from different wards/clinics for on-site DBS testing are not reaching the testing point. • HIV+ pregnant women identified at ANC or maternity not bringing infants for DBS testing at 6 weeks. • Inefficientreferral system for EID testing from lower-level health centers not trained in EID.
Key Issues. • Provision of results • Caregivers unclear when/where to return for results. • Poor appointment system to trigger follow-up. • Inadequate care provision undermines importance of infants returning regularly. • Long sample and result turnaround times.
Way forward. • Improve follow-up and linkage of the tested babies to care and treatment. • Improve turnaround time of DBS results. • Coordination and monitoring of ANC/PMTCT sites,testing labs, and sample/results transportation. • Coordinated training and sample transportation (use of Kaabong for Northern Karamoja & Moroto for Southern Karamoja). • Use of the courier system (future plan).
Way forward cont; • Integrate EID in routine services • Child health days . • Routine immunization outreaches. • Nutritional screening and treatment centre's. • Improving clinic-level systems to ensure that each infant makes it successfully from one point to the other. • Establishing a single follow-up point at each facility especially at HSD and hospitals. • Strengthening provision of routine care in EID services & visvasa. • Creating referral systems within the facility.
