Chiwoko, J

Mhango, E

Phiri, S

Weigel, R

English

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J Chiwoko

E Mhango

S Phiri

R Weigel

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Journal of the International AIDS Society

Promoting presumptive diagnosis of severe HIV disease to increase uptake of antiretroviral therapy in HIV-infected infants

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POSTER PRESENTATION Open Access
Promoting presumptive diagnosis of severe HIV
disease to increase uptake of antiretroviral
therapy in HIV-infected infants
J Chiwoko1*, E Mhango2, S Phiri1, R Weigel1
From Tenth International Congress on Drug Therapy in HIV Infection
Glasgow, UK. 7-11 November 2010
Purpose of the study
Despite successful scale up of anti-retroviral therapy
(ART) in Malawi, the number of children initiating ART
early in their life is low and mortality of HIV infected
infants not accessing ART is high. Availability of PCR
remains limited and despite presumptive diagnosis (PD)
is recommended in the national guidelines, it is rarely
used as a reason to start HIV-exposed infants on ART.
Reasons may include factors at health worker and clinic
level. Knowledge of these barriers is important to
increase access to ART for this high risk group.
Methods
A structured questionnaire with 11 closed questions was
administered to one ART clinic staff member for each
site (nurse or clinician) by team-members of the regular
national ART supervision for Quarter 1/2009 in the cen-
tral and southern region. Questions addressed specific
reasons for low uptake of PD and tested providers’
knowledge of the PD definition. Finally, the interviewer
explained how to make a PD correctly using a job-aid.
Results
Over 2 weeks, respondents of 49 of 173 ART-sites com-
pleted the questionnaire. They were mainly clinical offi-
cers (22) and nurses (17) from a central hospital, 5
district hospitals, 3 rural hospitals, 13 health centers,
and 27 other facilities such as mission hospitals, smaller
clinics run by NGOs, armed forces or privately. Forty-
one clinics provided HIV testing and counseling for
pregnant women on-site and 35 clinics offered antiretro-
virals for PMTCT. Most providers felt that children <18
month of age are under-represented in their ART-
cohort, mentioned that generally few HIV exposed chil-
dren are eligible for ART in their catchment area and
that limited access to PCR are reasons for low uptake of
PD (34/49 respondents each). Twenty-nine saw the pre-
sence of maternal HIV-antibodies as a barrier that
makes the diagnosis difficult, and 20 noted that staff at
the under 5 clinic or postnatal ward rarely identifies and
refers HIV exposed infants to HIV-services. Twelve pro-
viders said they generally don’t register children at that
age. Of the 49 providers, 15 defined presumptive diag-
nosis correctly and 15 partly correct.
Conclusions
Providers seem to be aware of the need to start more
HIV-infected infants on ART and of structural barriers
to access this service. Improved knowledge and sensiti-
zation of providers on how to diagnose severely ill HIV-
exposed infants presumptively may increase access to
ART for children in this age-group.
Author details
1Kamuzu Central Hospital, Lighthouse Trust, Lilongwe, Malawi. 2Ministry of
Health, HIV department, Lilongwe, Malawi.
Published: 8 November 2010
doi:10.1186/1758-2652-13-S4-P155
Cite this article as: Chiwoko et al.: Promoting presumptive diagnosis of
severe HIV disease to increase uptake of antiretroviral therapy in HIV-
infected infants. Journal of the International AIDS Society 2010 13(Suppl 4):
P155.
1Kamuzu Central Hospital, Lighthouse Trust, Lilongwe, Malawi
Full list of author information is available at the end of the article
Chiwoko et al. Journal of the International AIDS Society 2010, 13(Suppl 4):P155
http://www.jiasociety.org/content/13/S4/P155
© 2010 Chiwoko et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


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Promoting presumptive diagnosis of severe HIV disease to increase uptake of antiretroviral therapy in HIV-infected infants

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