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Table 4 Drivers of Loss at Each Point in the EID Continuum of Care

From: Retention outcomes and drivers of loss among HIV-exposed and infected infants in Uganda: a retrospective cohort study

  HEI not identified and tested HEI not receiving results and completing testing algorithm HIV+ infants not enrolling in care at HIV/ART Clinic HIV+ infants not started on ART & retained in chronic care
EID Clinic Systems and Patient Flow • EID fragmented across multiple clinics that are poorly equipped to test, follow-up and provide care for HEI
• Ad-hoc and ineffective flow of caregivers, samples, results, and data within the health facility
 
Referral and Data Management Systems • No referral mechanisms to link HEI from entry points to EID testing • No longitudinal tracking tools or appointment systems for HEI • No referral mechanisms to link HIV+ infants from EID to HIV/ART Clinic  
Clinical Care and Visit Schedule • Poor clinical care and HEI not visiting every month: prevents early identification of opportunistic and other HIV-associated infections
• Clinical care not integrated into EID services: undermines importance of HEI returning regularly to clinic
Counseling Messages, Materials and Techniques • Caregivers not convinced to get their HEI tested • Caregivers not convinced to return to the clinic • Caregivers not convinced to enroll HIV+ infant • Caregivers hesitant to start & adhere to ART
Knowledge and Awareness of Health Workers • Many HWs do not know how to screen and identify HEI • Many HWs not proficient in HEI testing and feeding algorithm • Many HWs not proficient in testing/feeding algorithm • Many HWs do not know ART criteria; uncomfortable initiating infants on ART
DBS Sample-Result Turnaround Time   • Test results not back in time for caregiver visits   
  1. HEI HIV-Exposed Infant, HW Health Worker, DBS: Dried Blood Spot ART: Antiretroviral Therapy