Difficulties with implementation
Polly Clayden, HIV i-Base
A study from Swaziland, conducted by the national ART programme and the Clinton Foundation, highlighted the difficulties of treatment initiation in infants following early diagnosis. 
Since March 2007 the EID programme using DNA PCR was expanded in response to high infant mortality in HIV-infected children. By November 2008, however, this had led to neither an increase in infants receiving treatment nor a decrease in mortality.
The study was a retrospective record review of all infants testing positive at 15 health facilities in the Manzini Region from January to August 2008. The investigators reported that 78% of results were available at the facility, and 44% of results were documented as having been received by the caregiver. Only 58/176 (33%) of children were enrolled at an ART centre and 34 initiated on treatment. Of those with data available 81% were eligible for ART, and among eligible children, 82% initiated treatment. Overall 19% of infants testing positive were initiated on treatment at the time of the evaluation.
This study found that the greatest points of loss are return of the result to caregivers and infant enrolment at the ART centre for treatment.
This article first appeared in issue 36 of the Journal of HIV Medicine, the journal of the Southern African Clinicians Society.
Unless otherwise stated, all references are to the programme and abstracts of the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 19 – 22 July 2009, Cape Town.
6. Sundaram M et al. Identification patient loss points from testing to treatment initiation among infants tested in Swaziland. Abstract MOPDD103. http://www.ias2009.org/pag/Abstracts.aspx?AID=1981