Drops of Hope: Reaching HIV-Exposed Infants in Malawi
Los Angeles, California
November 28, 2011
It’s a warm spring morning and the Likuni Mission Hospital softly hums with activity. Mothers with small children playing quietly in their laps wait in the shade. Men and women queue patiently for their prescriptions. Hospital staff walk swiftly in the heat to their next appointments. Dust swirls around the collage of small buildings with even smaller rooms that wrap around the hospital grounds.
Likuni Mission Hospital.
I can tell that my guide, Abigail, is quite popular here. We’re stopped every few feet by nurses and other hospital staff who are excited to say hello and to meet her American guest. Before she joined the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) last year, Abigail worked here at Likuni. I can see that her first-hand knowledge of the clinic’s inner-workings is vital to our work to reach more HIV-exposed infants.
Worldwide, more than 1,000 children are newly infected with HIV every day. And of these, more than half will die before their first birthday because of a lack of access to treatment. HIV in infants and young children can lead to rapid illness and death, which is why it’s so important to identify exposed infants as early as possible.
Foundation Technical Officer for Malawi Abigail Bonongwe.
This can be challenging in settings like Malawi and other countries in sub-Saharan Africa, where the vast majority of new pediatric HIV infections occur. Only an estimated 6% of babies born to HIV-positive mothers receive an HIV test within the first two months of life, and many parents don’t return to the clinic to receive the results.
This low-uptake of testing is further complicated by the fact that infants must be tested using more complex approaches, and healthcare workers often lack the knowledge and capacity to perform the tests.
The net result of these challenges is that HIV-positive infants and young children often go undiagnosed-- and as a result, untreated. Improving the uptake of HIV testing, the receipt of HIV test results, and the initiation of anti-HIV therapy for this most vulnerable age group remains a critical need.
Through the generous support of ViiV Healthcare, our Malawi team has been piloting a number of innovative approaches to address these issues in three hospitals in Malawi’s capital—including Likuni Hospital. And in a few minutes, I see first-hand why this ViiV-supported project is truly making a difference in the lives of mothers and their infants.
We visit Likuni’s maternal and child health corner where a handful of HIV-positive moms and their babies wait to see the health surveillance assistant for their checkups. The first two mothers I meet have a quiet strength about them. Their HIV-negative babies are smiling and healthy—one seems to be very interested in my impromptu game of “peek-a-boo,” whereas the other is more concerned with napping.
The health surveillance assistant first weighs, then measures the height of each infant—with moms helping out. Each woman is asked about her health and the health of the baby. Vital information is recorded in each baby’s health card and the hospital’s health registers. And before you know it, the moms have tied their babies onto their backs with their colorful traditional wraps – known as chitenjes – and are ready to go.
The next woman who enters the room has a different air about her. She seems a bit nervous and anxious. I find out from Abigail that today is a very important day for this mom and her baby. Her infant is having her first checkup -- and she will be tested for HIV.
A mother waits to have her infant's six-week
check-up, where she will be tested for HIV.
A key component of this project is educating HIV-positive women about the importance of bringing their babies back to the clinic at six weeks of age so that they can be tested for HIV. This new mother proudly informs the health surveillance assistant that she brought her baby in a day early since the clinic would be closed on Saturday…which would have been the exact six-week mark. When Abigail translates this back to me, I couldn’t help but smile.
Since an infant at this age still has antibodies from the mother, traditional tests that look for HIV antibodies can’t be used. Instead, “dried blood spot” testing (or DBS), which can determine whether the actual virus is present or not, is used. The baby’s toe is pricked and small amounts of blood are collected on filter paper, dried for several hours, and then transported to a laboratory for analysis. And while DBS testing allows for easier collection and transport of samples, it also requires specialized training.
Before this project, there weren’t enough health surveillance assistants here at Likuni who knew how to perform DBS collection. Thanks to our ViiV-supported project, four additional health surveillance assistants at Likuni are able to carry out DBS collection. And when I find out that the assistant I am observing is one of the four recently trained because of our efforts, , my smile grows even wider.
The new mom is instructed to rub the toes of the baby to help facilitate the blood collection. While mom holds her infant, the health surveillance assistant swiftly pricks a toe of the baby and adeptly collects five spots of blood on the filter card. Remarkably, the baby doesn’t make a fuss, and the sample collection is completed in a matter of minutes. This baby’s card is left to dry with the rest of today’s DBS samples.
As I look at the samples, I think to myself that the spots on these cards represent tiny drops of hope…hope that these infants will be HIV-negative, and stay that way as they grow older.
When I review the hospital registers, I check the “HIV-status” column for the last handful of HIV-exposed babies that have attended the clinic.
Row after row, I see the most welcomed word in our HIV/AIDS lexicon: “NEGATIVE”.
Even more signs of hope.
Colleen Murphy, PGDip, is a Senior Program Manager for Private Donor Agreements for the Foundation, based in Los Angeles
*All photos are courtesy of EGPAF/Colleen Murphy