Assessment of the Care and Treatment of HIV-Exposed Infants Born at ENHAT-CS-Supported Health Centers

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Mother-to-Child Transmission of HIV and Early Infant Diagnosis:The Global Situation

An estimated 3.2 million children were living with HIV at the end of 2013; 91% of them were in sub-Saharan Africa.2 Without prevention of mother-to-child transmission (PMTCT) interventions, 30 to 35% of infants born to HIV-infected women will acquire HIV in utero, during birth, or during breastfeeding.3 With effective interventions, however, the risk of mother-to-child transmission can be reduced to 2% or less. Though much progress has been made in prevention and treatment of HIV, a large proportion of HIV-infected pregnant women do not access antenatal care (ANC), and are neither tested for HIV nor receive antiretroviral therapy (ART) during pregnancy. Moreover, many who start ART are not followed after delivery.

Prevention of Mother-to-Child Transmission of HIV and Early Infant Diagnosis in Ethiopia

In the beginning of 2012, the Government of Ethiopia embarked on an accelerated plan for PMTCT focusing on creating demand for, increasing access to, and improving the quality of PMTCT services.The same year, the Federal Ministry of Health introduced a manual to guide program managers on the planning, implementation, coordination, monitoring, and evaluation of early infant diagnosis and treatment services. Many programs, including the Ethiopia Network for HIV/AIDS Treatment, Care, & Support (ENHAT-CS) program, a USAID initiative funded by PEPFAR, have been involved in the implementation of this manual and the initiation of care programs for HIV-exposed infants (HEIs) at the primary health care level in Ethiopia.Yet between October 1, 2012 and September 30, 2013, only half of HEIs in Amhara and Tigray,the regions supported by ENHAT-CS, had been tested for HIV within two months of birth.Among the HEIs tested, 10% were HIV-infected and just 72% of those who tested positive were enrolled on ART care and support.

ENHAT-CS estimates that about 50% of all HEIs in these two regions were born in health centers.The birth of an HEI at a health center is an opportunity to enroll the baby in HEI care, which includes early infant diagnosis, infant prophylactic treatment, other treatments to prevent HIV and other infections, promotion of healthy feeding practices, and routine infant services such as growth monitoring and immunizations. However, routine service data reports on all HEIs registered at the health center does not readily show enrollment rates and subsequent health outcomes specifically among HEIs who were born in health facilities.The program therefore assessed enrollment and clinical outcomes of HEIs born at ENHAT-CS-supported health centers between October 2011 and September 2013.