Implementation and Operational Research: 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.