Identifying Key Gaps in Service for HIV-Exposed Infants within USAID Supported PEPFAR Programs Open Access

Amanuel, Hanna (Spring 2022)

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Background: HIV-exposed infants (HEI) are vulnerable to HIV acquisition and high rates of mortality if they are not tested early and linked to appropriate treatment. Programs supported by the President's Emergency Plan for AIDS Relief (PEPFAR) have implemented interventions aimed at the prevention of mother-to-child transmission (PMTCT) of HIV, scale-up of pediatric case identification through family index testing, increasing ART optimization, and providing comprehensive care to children living with HIV (CLHIV). Despite efforts to improve care for HEI, significant gaps exist in retaining mothers within prevention services, timely infant HIV diagnostic testing, and enrollment into comprehensive care services. An analysis of country-specific priorities, initiatives, and barriers is needed to support country teams to improve HEI outcomes across the clinical cascade. 

Methods: A 17-question survey was developed and sent to all United States Agency for International Development (USAID) headquarters (HQ) country backstops within the Pediatric and Maternal Branch (PMB) and Orphans and Vulnerable Children (OVC) Program, Mission PMTCT and OVC point-of-contacts, and Implementing Partners (IP). The survey aimed to elicit information from respondents about current gaps in services for HEI and their mothers across all PEPFAR/USAID-supported countries. Survey responses were extracted into Google Sheets and a qualitative review of responses was conducted with job title and country disaggregated, as appropriate, for comparative analyses. 

Results: Survey data from 40 eligible respondents were analyzed, including five USAID HQ colleagues, 15 mission point-of-contacts, and 20 implementing partner staff members across 19 different countries. Barriers identified by respondents were summarized and used to inform the development of a technical consideration document, screening tool, and job aid for country team distribution. An in-depth qualitative analysis of country responses was provided to country backstops for programmatic use. 

Discussion: The survey gathered insight on technical assistance needed at the country level to strengthen coordination and inform how to close gaps in service for HEI. Data suggested a need for country programs to prioritize comprehensive care by improving clinical and community partner collaborations. Challenges in providing care to HEI are country-specific and require programmatic revision to ensure adequate targeting and contextual consideration. 

Table of Contents

Chapter 1: Introduction 1

Problem Statement 2

Purpose 2

Main Research Question 3

Significance Statement 3

Definition of Terms and Abbreviations 4

Chapter 2: Literature Review 7

PMTCT Program Enrollment and Retention 8

Early Infant Diagnostic Testing 11

Prophylaxis and Treatment: 13

Comprehensive Care for HEI 16

Chapter 3: Methods 18

Survey Description and Goal 18

Materials and methods 19

Participants 20

Chapter 4: Results 21

Participant Results 21

Challenges Identified in Retaining Mothers in PMTCT Programs 23

Early Infant Diagnosis 25

Comprehensive Care for HEI 27

Technical Assistance 28

Chapter 5: Discussion 29

Strengths 32

Limitations 33

Implementation Guide/Toolkit 34

References 37

Appendix A: Survey Questionnaire 43

Appendix B: Survey Results Presentation Highlights 47

Appendix C: HEI/OVC in COP22 Guidance 54

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