5th International AIDS Society Conference on HIV Pathogenesis and Treatment Cape Town - July 19 - 22, 2009

IDENTIFICATION PATIENT LOSS POINTS FROM TESTING TO TREATMENT INITIATION AMONG INFANTS TESTED IN SWAZILAND

IAS Conf HIV Pathog Treat 2009 Jul 19-22;5th: Abstract No. MOPDD103

M. Sundaram ¹, B. Lukhele^2
1Clinton Foundation HIV/AIDS Initiative, Center for Strategic HIV Operations Research, Boston, United States, ²Swaziland National ART Programme, Mbabane, Swaziland

BACKGROUND: Since March 2007, early infant diagnosis (EID) in Swaziland has expanded and has enabled the identification of more than 1,300 HIV positive infants. However, the number of children on treatment is still low, suggesting that many are lost to follow-up prior to treatment initiation.

METHODS: The Clinton Foundation, in conjunction with the Swaziland National ART Programme (SNAP), conducted a retrospective review of HIV positive children within the Manzini region in Swaziland to describe loss to follow-up. The children were tested via dried blood spot (DBS) from January to August 2008. We identified the positive results and the achievement of process steps from diagnosis to initiation in November 2008 with review of laboratory database, DBS logbooks, under-five registers, ART registers and electronic data at testing and ART treatment sites.

RESULTS: We reviewed the cases of 176 HIV-positive children tested at 15 sites at least two months before the study. Of these, 98% of tests were completed, 78% of results were available at the facility, and 44% of results were documented as having been shared with the caregiver. In all, 58 children were enrolled at an ART site, only 33% of the total evaluated. Among enrolled children, 72% and 64% had CD4 percent and WHO stages documented in their chart, respectively, and 81% of those assessed were eligible for ART. Among eligible children, 82% initiated treatment. Looking over the continuum, 34 of the 176 HIV positive children (19%) were initiated on ART at the time of our study.

CONCLUSIONS: The findings of this study suggest that the greatest points of loss are return of the result to caregivers and enrollment at the ART center for treatment. The study highlighted some of the challenges with the existing sample transportation system, substantial variability among sites, and suggests areas for process improvement.

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2009-07-22
MOPDD103
Operations Research to Improve Laboratory Diagnosis and Monitoring

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