Scaling up of early infant diagnosis in conflict-affected Northern Uganda

Issues: Early HIV diagnosis of babies born to HIV+ mothers remains the entry point into any HIV care service and is crucial for their prognosis, since initiation into treatment prior to 12 weeks of age can reduce mortality up to 75% of the HIV-infected babies. Current available technologies allow Early Infant Diagnosis (EID) as early as 6 weeks of life.

Description: To scale up EID and early linkage to care, Northern Uganda Malaria, AIDS and Tuberculosis (NUMAT) program trained staffs in health units where HIV-exposed babies are likely to be encountered. Training included identification of cases, blood collection, sample storage, packaging and transportation. Consumables were provided to the facilities after training. EID was made an integral part of mother-baby pair follow-up.

Lessons learnt: By December 2008, a total of 448 health workers from 59 health facilities were trained on EID. From June to December 2008, out of the expected HIV exposed 5,250 babies the 42% (2,192 babies with a median age of 3 months) were tested for HIV using the DNA-PCR method. Of them, 327 (14.9%) were found positive. All the HIV positive babies were referred for HIV care and the negative ones counseled on infant and young child feeding and need for repeating the test after cessation of breast feeding.

Recommendations: Scale up of EID is possible even in resource constrained settings. Scaling up of PMTCT needs to be integrated with EID and pediatric HIV care.