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Background

More HIV positive infants and mothers identified through HIV testing in immunization clinics in Malawi Erik Schouten, Michele Sinunu , Nellie Wadonda , Enock Kajawo , Michael Eliya , Frank Chimbwandira , Scott Kellerman Management Sciences for Health, Ministry of Health Malawi

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  1. More HIV positive infants and mothers identified through HIV testing in immunization clinics in Malawi Erik Schouten, Michele Sinunu, Nellie Wadonda, EnockKajawo, Michael Eliya, Frank Chimbwandira, ScottKellerman Management Sciences for Health, Ministry of Health Malawi 26 July 2012, 19th International AIDS Conference, Washington

  2. Background • Evaluation of Malawi´s national PMTCT program through an immunization clinic surveillance project designed to obtain population-based vertical transmission rates. • The evaluation was carried out in August – November 2011, before the a newly implemented policy (option B+) could have effect.

  3. Methods • Infants < 3 months old and their care-givers attending the first immunization visit • 53 randomly-selected immunization clinics in 4 districts in Malawi • Questionnaire • Infant dried blood spots (DBS) were collected • ELISA HIV test to determine maternal HIV-status • ELISA positive tests were tested by DNA-PCR • DNA-PCR positive HIV-infected infant • ------------------------ = ------------------------ = vertical transmission • ELISA (HIV) positive HIV-infected mother

  4. Methods (2) • One of the research questions: • What is the additional number of infants and mothers in need of HIV care that could be identified if HIV testing was introduced in immunization clinics? • Mothers' responses about previous HIV testing • were compared with ELISA (HIV) test results

  5. Results • An additional 207 (37%) mother/infant pairs were identified among women that had never been tested or tested HIV-negative before or during the pregnancy • Yield of testing all 4,809 women/children who were never tested before, or tested negative before or during the pregnancy is 207/4,809 = 4.3% • A reported HIV-positive test result could not be confirmed in (100-92.4 =) 7.6% of patients with a reported HIV-positive status. • Vertical transmission was 67/794 = 8.4% (at 6 weeks)

  6. Possible reasons • HIV incidence in pregnancy (estimated at 1% according to a recent study in Malawi *)) • False negative or false positive HIV test results • Recall bias *) Keating et al. HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe, Malawi: Implications for the Risk of HIV Acquisition. PLoS ONE 7(6): e39109. doi:10.1371/journal.pone.0039109

  7. conclusions • HIV testing in immunization clinics can help to identify an important number of HIV-infected-exposed mother-infant pairs • We need to critically look at the quality of HIV testing • Base-line can be repeated as part to evaluate Option B+ (test and treat for pregnant and breastfeeding women)

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