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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