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EID Implementation Challenges

EID Implementation Challenges. Dr Angela Mushavi, Zim National PMTCT and Pediatric HIV Care and Treatment Coordinator XV111 IAS Conference 18-24 th July, 2010 Vienna, Austria. EID program in Zimbabwe.

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EID Implementation Challenges

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  1. EID Implementation Challenges Dr Angela Mushavi, Zim National PMTCT and Pediatric HIV Care and Treatment Coordinator XV111 IAS Conference 18-24th July, 2010 Vienna, Austria

  2. EID program in Zimbabwe • EID started as a pilot in 4 sites: Harare, Chitungwiza, Mpilo, Parirenyatwa hospitals in 2007 • SOP, data forms, algorithm (to be finalized) developed • Training of multi-disciplinary health workers • National Microbiology Reference Laboratory (NMRL) & a partner lab (Zvitambo) responsible for analysis • CHAI supports reagents and human resources • EMS system for transportation of specimens to and from sites and lab

  3. DBS specimens from few implementing sites in 2010

  4. 2009 DNA-PCR Tests Two laboratories with PCR capacity: -National Microbiology Reference Lab (NMRL) -Zvitambo Lab Current lab capacity to perform 24 000 HIV DNA PCR tests 4 143 PCR tests done in 2009, 846 (20.4%) were positive and 3 297 (79.6%) were negative (Not disaggregated by age at test) National coverage of EID is 13% out of all HIV-exposed infants Only 76 sites submitting DBS

  5. Enrolling HIV exposed and infected Children into Care • With PITC, all children presenting for any health service should be offered HIV testing: • 6 weeks postnatal visit for babies from PMTCT (increasingly) • All children presenting for routine child health care interventions, e.g. GMP (ask for and/check HIV-exposure status on child health card) • Inpatient and outpatient symptomatic children • New start centre (VCT) • TB hospital • Nutrition rehabilitation centre • Children whose parents are on ART or in pre-ART

  6. EID: the reality • Our treatment data tells us that many of the children on ART are older; not infants • Even with the adoption of PITC by MOHCW, question is: To what extent is this happening for children in-country? Figures clearly show that infant testing rates are low • Staff that are trained lack confidence to perform DBS on babies, and there is delay in starting to submit samples by recently trained staff • Sites do not always have staff trained in EID, and therefore do not submit DBS • For some of those sites that have been trained in DBS, there are no bundles available • The result: HIV-infected children die needlessly before they even go on ART; or much later when they advanced HIV disease

  7. Take home message • Enhancing laboratory capacity to test is excellent; but EID programs should create health care worker momentum for early testing of children • Community mobilization to increase demand for early HIV testing of children • Training, mentorship and supportive supervision of health care workers in DBS collection is critical • Provide adequate training and supplies to conduct DBS collection

  8. Thank you

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