Provision of Services and Care for HIV-Exposed Infants: A Comparison of Maternal and Child Health Clinic and HIV Comprehensive Care Clinic Models

Ong'ech, John Odero MBChB, MMed, MPH*,†; Hoffman, Heather J. PhD; Kose, Judith MBChB, MMed§; Audo, Michael MBChB, MPH§; Matu, Lucy MBChB, MSc§; Savosnick, Peter MA§; Guay, Laura MD†,‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 September 2012 - Volume 61 - Issue 1 - p 83–89
doi: 10.1097/QAI.0b013e31825bd842
Epidemiology and Prevention

Objective: Prevention of Mother-to-Child Transmission of HIV programs require follow-up of HIV-exposed infants (HEI) for infant feeding support, prophylactic medicines, and HIV diagnosis for at least 18 months. Retention in care and receipt of HIV services are challenging in resource-limited settings. This study compared infant follow-up results when HEI services were provided within Maternal and Child Health (MCH) clinics or in specialized HIV Comprehensive Care Clinics (CCCs) in Kenya.

Methods: This observational prospective cohort study enrolled HEI at 6–8 weeks of age in 2 purposively selected hospitals with similar characteristics but different models of service delivery. In the CCC model, HEI received immunization and growth monitoring in MCH but cotrimoxazole prophylaxis and infant HIV testing in the CCC. In the MCH model, all services were provided in the MCH. Data were collected at enrollment, 14 weeks, and 6, 9, and 12 months.

Results: From April 2008 to April 2009, 184 HEI were enrolled in the CCC cohort and 179 in the MCH cohort. Infants in MCH were 1.14, 1.42, 1.95, and 1.29 times more likely to attend 14-week, 6-, 9-, and 12-month postnatal visits, respectively, and 2.24 times (95% confidence interval: 1.57 to 3.18) more likely to attend all 4 visits. Although infants in MCH were 1.33 times (95% confidence interval: 1.10 to 1.62) more likely to have HIV antibody testing at 1 year than CCC, there were no differences for polymerase chain reaction test or cotrimoxazole initiation at 6–8 weeks.

Conclusions: HIV services integrated in MCH yield better follow-up of HEI than CCC.

*Department of Obstetrics and Gynaecology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya

Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya

Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC

§Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya

Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC.

Correspondence to: John Odero Ong'ech, MBChB, MMed, MPH, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Kenya Ariel House off David Osieli Road - Westlands, P. O. Box 13612 00800, Nairobi, Kenya (e-mail: jongech@pedaids.org).

Supported by the Elizabeth Glaser Pediatric AIDS Foundation.

The authors have no conflicts of interest to disclose.

Received November 6, 2011

Accepted April 19, 2012

© 2012 Lippincott Williams & Wilkins, Inc.