Background: Routine HIV testing for HIV-exposed infants (HEI) and prompt ART initiation for HIV-infected infants are both critical to prevent early HIV-related morbidity and mortality. However, in the Manzini Region of Swaziland, while HIV testing coverage among HEI routinely exceeds 95%, only 27% percent of infants diagnosed with HIV in July-December 2016 were initiated on ART. We describe efforts between key stakeholders to determine reasons for low ART initiation among HIV-infected infants in Manzini, and develop and implement interventions to increase timely ART initiation within this population.
Description: From January-June 2017, Swaziland Ministry of Health Regional Health Management Team for Manzini, health facility staff and ICAP, collaborated to conduct a rigorous data-driven performance review and bottleneck analysis of ART initiation among HIV-infected infants in Manzini. This effort informed the design and implementation of interventions, including intensified tracking strategies of HIV-infected infants from the laboratory to facility and community as well as mentorship on infant ART initiation. Additionally, program data reported for early infant diagnosis was validated with the information from laboratory and facility registers to identify reporting errors and improve their accuracy.
Lessons learned: Collaboration between key stakeholders was essential to effectively identify problems across health system elements (e.g., laboratory, facilities) that contributed to low infant ART initiation, and design and implement system-wide strategies to improve performance. A key tool was the use of testing to treatment data cascades, from blood sample collection, laboratory testing, identification of HIV-infected infants to ART initiation. Implementation of active tracking of infected infants was a critical intervention. Overall, ART initiation coverage reached 94% (30/32) for infants aged between 6 weeks -11 months diagnosed with HIV in January-June 2017. Finally, the program data validation identified and eliminated double counting of confirmatory DNA PCR tests.
Conclusions/Next steps: New HIV infections among infants remain evident and efforts must be made to find these infants through early infant testing. High coverage of early and timely ART amongst infants with HIV-infection is feasible provided, health care teams continue to monitor and improve, using quality data, outcomes of early infant diagnosis and ART initiation among this sub-population.



[Infant testing to treatment Cascade]

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