An Integrated and Comprehensive Service Delivery Model to Improve Pediatric and Maternal HIV Care in Rural Africa.

BACKGROUND: Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa.

METHODS: From 12/2012, we implemented an intervention package to improve Prevention of Mother-To-Child Transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: a) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; b) implementation of electronic medical records; c) provider-initiated HIV testing and counseling in the hospital wards; and d) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period prior (2008-2012) and during/after the implementation (2013-2014).

RESULTS: After the intervention, the number of mothers and children enrolled into care almost doubled. Compared to the pre-intervention period (2008-2012), in 2013-2014 children presented lower CD4% (16 vs. 16.8, p=0.08) and more advanced disease (WHO stage 3/4 72% vs. 35%, p<0.001). The antiretroviral treatment coverage rose from 80% to 98% (p<0.001), the lost to follow-up rate decreased from 20% to 11% (p=0.002) and mortality ascertainment improved. During 2013-2014, 261 HIV-exposed infants were enrolled and the early mother-to-child transmission rate among mother-infant pairs accessing PMTCT was 2%.

CONCLUSION: This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.