Swaziland COE Early Infant Diagnosis Follow-up and Linkage to Care Program
For the past few days, I have been working with one of the PAC doctors, Michelle. As the story often goes—she has an incredible grant, an incredible idea, and is working on its implementation. Alone. Early Infant Diagnosis (EID) was introduced in Swaziland in 2007 (see previous post) in 10 hospitals and health centers. 2372 infants were tested using DBS DNA PCR testing (see previous post), and 461 (19%) tested positive. Since the roll-out to 42 rural health centers and clinics from March-August of 2008, an additional 4200 DBS tests have been completed with 482 (12%) positive results. Although DBS is identifying more positive children, only about 50% of infants are actually returning for results. So, while almost 1000 children are receiving early diagnosis, only half are being referred for care and treatment. As discussed previously, mortality decreases significantly with early initiation of ART therapy, and it is vital to close the gap between testing and linkage to care.
As the lead partner in DBS training and roll-out in Swaziland, Baylor has an opportunity to look for strategies to strengthen links between diagnosis and treatment. Many of the outreach clinics are utilizing expert clients (see previous post—openly (+) translators) to initiate counseling and follow-up with exposed infants. They hope to expand the role of the expert client to focus on tracking patients with positive results and linking them with HIV care.
Michelle has been given a grant to provide 20+ outreach ARV clinics with cell phones and “airtime” in order to communicate with HIV (Reactive) mothers who bring their newborns in to the clinic for DBS DNA PCR tests and never return to receive their results. Her program, “Swaziland COE Early Infant Diagnosis Follow-up and Linkage to Care Program”, was launched at 8 outreach clinics about two months ago and will launch at 20+ sites next year.
In Swaziland (and in most of Africa), it costs a tremendous amount of money to make phone calls, and costs next to nothing to send a text message. Right now, the expert clients are calling the mothers, sometimes five or six times, in order to remind them to pick up their test results. Needless to say, they could benefit from a cheaper, text-message based communication system. Insert FrontlineSMS (www.frontlinesms.com). Using this system, the clinics could communicate with the labs in order to give patients their results while they are in the clinic for their monthly follow-up appointments, mothers (or CHWs) could be contacted when their results are available, and records could be kept of follow-up attempts for a retrospective analysis of the implications of the project. This is a work in progress—hopefully, more will come soon.