Intensified counseling by CHW improves early infant diagnosis
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Mphatso, a 41 year old woman from Chigolo Village, Lifuwu, was diagnosed with HIV at Lifuwu Health Centre antenatal department during a routine visit. After diagnosis and counselling, she started antiretroviral treatment (ART) to improve her health and help prevent transmission of the virus to her unborn baby.
Throughout her pregnancy, she took her treatment carefully, ensuring good adherence to protect her baby, and when her healthy young boy, Moses, was born, she gave him Nevirapine syrup once daily as prescribed by the nurses in antenatal clinic. Duncan Phiri, Site Supervisor at Lifuwu Health Centre, first met Mphatso during one of her visits to the clinic for a refill of her ART. Noticing that three month old Moses had not yet received a DNA PCR test for early infant diagnosis (EID) of HIV, he counseled Mphatso and asked if he could perform a test on the child. She refused, explaining sadly that her child had already been tested and was infected with HIV. |
Tingathe CHW and HTC Counsellor, Duncan Phiri, conducting a counselling session on exposed infant care to HIV-infected mother, Akwete, and her exposed infant, Moses
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Knowing the EID testing cascade in Malawi very well, Duncan had his doubts about the diagnosis and probed further. After a close review of Moses’ records and a discussion with the clinicians at the facility and his Tingathe clinical mentor colleagues, the team learned that the child had received a rapid HIV test rather than a DNA PCR. Although Moses’ positive result reflected that he was exposed to HIV, Mphatso had been mistakenly counseled that the result meant her child was infected with HIV.
After an intensive counseling session during which Duncan explained the difference between DBS and rapid HIV tests, the meaning of a positive rapid test for a child under twelve months and the importance of proper EID testing for infants in the prevention of mother to child transmission (PMTCT) cascade, Mphatso expressed relief and agreed for Moses to receive a DNA PCR test to confirm the result. Two months later, the result was back and Duncan made a home visit to Mphatso to deliver the news. Mphatso was relieved to hear that the result was negative and that if she continued taking her ART properly, attending all of her and Moses’ health appointments and practicing exclusive breastfeeding, the chance of transmission would be low. Duncan and the other Lifuwu community health workers continue to follow Mphatso and Moses up at the health facility as well as provide detailed EID counselling to all HIV-infected expecting mothers to ensure the same mistake is not made in the future.
After an intensive counseling session during which Duncan explained the difference between DBS and rapid HIV tests, the meaning of a positive rapid test for a child under twelve months and the importance of proper EID testing for infants in the prevention of mother to child transmission (PMTCT) cascade, Mphatso expressed relief and agreed for Moses to receive a DNA PCR test to confirm the result. Two months later, the result was back and Duncan made a home visit to Mphatso to deliver the news. Mphatso was relieved to hear that the result was negative and that if she continued taking her ART properly, attending all of her and Moses’ health appointments and practicing exclusive breastfeeding, the chance of transmission would be low. Duncan and the other Lifuwu community health workers continue to follow Mphatso and Moses up at the health facility as well as provide detailed EID counselling to all HIV-infected expecting mothers to ensure the same mistake is not made in the future.
