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. 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

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

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

DBS performance by district

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 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.

Thank you for listening

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 Complexity of EID & points to lose exposed infants