1. Early Infant Diagnosis using DBS: highlighting challenges Denis Tindyebwa Director Pediatric Care and Treatment Elizabeth Glaser Pediatric AIDS Foundation

2. EID Reaching children “missed” by PMTCT Entry point Number of infants tested Number of infants tested positive % PMTCT332434010,23% non PMTCT53225648,12% Total385659615,46%

3. Identifying and testing exposed infant Only 10-50% PMCTC sites offer EID services Less than 50% exposed children tested Less than 20% of PMTCT mothers linked to tested infants Average age at 1 st DBS is over 6 months – only 40% tested within 3 months Very few exposed children identified in MCH, Ped wards, OPD Going beyond specimen collection and checking basic clinical parameters – weight, etc

4. Taking specimens - DBS Who orders the test, now & later Clear simple SOPs No of staff able to take specimen; – Task shifting? Quality of specimens; Feedback to sites on quality of specimen

5. Going beyond doing PCR testing 10% exposed children started on CTX within 8 weeks 35% infants receiving results never enrolled in care 54% Infants enrolled in care not started on ART

6. DBS PCR Cascade July 08 –April 2009

7. Conclusion Implementation of EID requires an integrated approach Planning and program implementation should always keep focus on intended outcome Newer technologies; simpler, cheaper better