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Scaling up Early Infant HIV Diagnosis (EID) in Karamoja Health Nutrition HIV coordination meeting 9 th December 2009.

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Presentation on theme: "Scaling up Early Infant HIV Diagnosis (EID) in Karamoja Health Nutrition HIV coordination meeting 9 th December 2009."— Presentation transcript:

1 Scaling up Early Infant HIV Diagnosis (EID) in Karamoja Health Nutrition HIV coordination meeting 9 th December 2009

2 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.

3 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

4 4 EID/DBS process Sample Collected at Health Facility Sample Dispatched from Facility Sample Received by Lab Results Processed and Packed in Lab Results Picked up for Transport 1 Results Returned to Caregiver Results Dropped at Health Facility 234567

5 130 Health workers have been trained in EID. Each district has at least one health facility providing EID services 261 Exposed babies (6 weeks – 18 months) have been tested for HIV through DBS (Jan – Sept 2009) 43 (16%) babies have tested HIV positive. Coverage of the service in Karamoja

6 DBS performance by district

7 7 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. Inefficient referral system for EID testing from lower-level health centers not trained in EID.

8 8 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.

9 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).

10 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.

11 Thank you for listening

12 12 Identify and test exposed infant Provide results to caregiver & guide through test algorithm Enroll positives in ART Clinic Retain alive in care/ treatment Exposed infants must be identified from multiple ‘entry points’ within the health facility & successfully referred for DBS testing Samples transported to JCRC Results transported back to health facility and appropriate HCW’s Caregivers must return to get results Infants must return for any follow-up visits Positive infants must be successfully referred to on- or off-site ART clinic Enrolled infants must be retained at ART clinic through requisite counseling and high quality care/treatment Given the rapid disease progression of HIV in infants, basic care and prophylaxis must be provided to infants throughout the EID process 1 234 Complexity of EID & points to lose exposed infants

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