A HIV free new generation in Central Province, Kenya. VIhDA Association Victorio Torres Feced June 24th 2008 Access Campaign – Experts roundtable Hotel

A HIV free new generation in Central Province, Kenya.

VIhDA Association Victorio Torres Feced

June 24th 2008

Access Campaign Experts roundtableHotel Le Grenil, Geneva

00002-E-* 1 December 2003

Estimated number of children (

Western & Central Europe200[

Western and Central Europe200[

Maragua AIDS care program

District population 396,675 - 40% live below poverty line; overall HIV prevalence is 5%. One district hospital, two mission hospitals, five health centres. Two ART initiation sites in the district (the district hospital and one mission hospital), five ART follow up sites. Computerised M+E at the district hospital (FUCHIA MSF-Epicentre)

May 2008: 63,839 people HIV tested since 2002 (4 testing strategies). MOH ART program started in 2004; provides free ARV medications (fixed dose combination) to 2800 patients (15% children).

Roles and responsibilities in the partnershipDistrict Health Management Team members: DMoH, DPHN, DTLC, DMLT, DHEO, DAO, DRO, DNO, DPHO, DASCO, Dphar, Medsup.

Patients on care in Maragua CCCFebrero 2004 Septiembre 200514% children

Why investing in optimized replacement feeding (formula +) for mothers opting not to breastfeed in Central Province?It has proved effective in erradicating postnatal pediatric HIV infection in industrialised and middle income countries.

Unlike breastfeeding, once RF is AFASS it has no legal implications*. Do infants born to HIV infected mothers have the right of not being breastfed? Breastfeeding is an absolute contraindication if mother is HIV infected in industrialized and middle income countries**

How long do we see HIV infected mothers breastfeeding in areas with limited resources? Vision 2030.* Naver et at, J Acquir Immune Defic Syndr 2006;42:484 Y 489 HIV Prevention ACT Penal Code of Kenya section 264 Convention of the Rights of the child: 24(1) article**Nelson textbook of pediatrics. Tropical pediatrics (Oxford University)

Kenya Health Demographic Survey 2006 (general population): Rates of mothers practising Exclusive Breastfeeding at 6 months : 2,6%Why investing in optimized replacement feeding..?

To what extent is exclusive breastfeeding for HIV infected mothers feasible? AFASS?

Mother to child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Coovadia et al. The Lancet 2007; 369:1107-1116.

Why investing in optimized replacement feeding..? Is early weaning safe? AFASS?Thomas T, et al Rates of diarrhea associated with early weaningamong infants in Kisumu, Kenya. CROI 2007, 14th Conferenceof Retroviruses and Opportunistic Infections, Los Angeles,California, US, 2007 [abstract 774].

Kourtis A et al. Diarrhea in uninfected infants ofHIV-infectedmotherswho stop breastfeeding at 6months: The Ban Study Experience.CROI 2007, 14th Conference of Retroviruses and OpportunisticInfections, Los Angeles, California, US, 2007 [abstract772].

Kafulafula et al. Postweaning gastroenteritis and mortality inHIV-uninfected African infants receiving ARV prophylaxis toprevent MTCT of HIV-1. CROI 2007, 14th Conference of Retrovirusesand Opportunistic Infections, Los Angeles, California,US, 2007 [abstract 773].

Onyango C et al. Early breastfeeding cessation among HIV-exposednegative infants and risk of serious gastroenteritis: findings froma perinatal prevention trial in Kampala, Uganda. CROI 2007,14th Conference of Retroviruses and Opportunistic Infections,Los Angeles, California, US, 2007 [abstract 775].

Coutsoudis A, Pillay K, Spooner E, Coovadia HM, Pembrey L,Newell M-L. Morbidity in children born to women infectedwith human immunodeficiency virus in South Africa: doesmode of feeding matter? Acta Paediatr 2003; 92:890895.

Abrupt and early weaning is a difficult process. By the time of weaning many women are already lost to follow up.

Rates of Gastroenteritis Hospitalizations by Infant Age, Comparing CDC HAART Study (KiBS) with Early Weaning to Natural History Study (VT) in Kisumu, KenyaAge in monthsAge of Weaning in KiBs( Mary Glenn Fowler MD)

Fallo en el crecimiento a partir de los 6 meses en el estudio KiBS (N=63) comparado con el estudio VT, sin destete precoz (N=440), Kisumu, Kenya(Mary Glenn Fowler MD)

P= 0.27P= 0.007Kuhn L et al. N Engl J Med. 2008; 359.

Mortality and HIV transmission by Mode Feeding in Randomized Breastfeeding vs Formula-Feeding Clinical Trial, Nairobi, KenyaNduati R, et al. JAMA 2000;283:1167-74Breastfed (N=191)

Formula-Fed (N=193)

37%(Mortality 24%) 21%(Mortality 20%)Overall rate of breast milk transmission was 16.2%;75% of occurred by 6 monthsP=0.001

18-Month Probability of Survival by Feeding Group, ANRS DITRAME 1201/1202 and 049a Uninfected childrenBecquet et al. PLoS Medicine. 2007;4:0139-0151 Comparison short-term breast vs formula: p= 0.83

Comparison long-term breast vs combined Ditrame Plus: p= 0.79

18-Month Probability of Survival by Feeding Group, ANRS DITRAME 1201/1202 and 049a Infected Children Becquet et al. PLoS Medicine. 2007;4:0139-0151 Comparison short-term breast vs formula: p= 0.61

Comparison long-term breast vs combined Ditrame Plus: p= 0.25

Given appropriate support RF can be safe for HIV infected mothers opting not to breastfeed in resource limited settings

Given appropriate nutritional counseling and care, access to clean water and a supply of breast-milk substitutes, these alternatives to prolonged breas-feeding can be safe interventions to prevent MTCT of HIV in urban African setting. Becquet et al. PLoS Medicine. 2007;4:0139-0151. Two year morbidity-mortality and alternatives to prolonged breast-feeding among children born to HIV-infected mothers in Cote dIvoire.

With appropriate education and access to clean water, formula feeding can be a safe alternative to breast-feeding for infants of HIV-1 infected mothers in resource-poor setting. Nduati R, et al. JAMA 2000;283:1167-74. Morbidity and mortality in breastfed and formula-fed infants of HIV-1-infected women (RCT).

Replacement feeding is effective in preventing MTCT and can be implemented in areas with access to safe water (Kayhelitsa, SA). Hilderbrand K, Goemaere E, Coetzee D. The prevention of mother-to-child HIV transmission programme and infant feeding practices. S Afr Med J 2003 October;93(10):779-81.

The dilema:

It is clear what to do to prevent mother to child transmission of HIV in resource limited settings the question is how to do it?

Sheet1

MARAGUA DISTRICT PMCT SERVICE STATISTICS. JANUARY- JUNE 2005

FacilityTotal ANCTotal 1 v.Tested 1 v.%Positive 1 v%Total rev.Tested rev.%Positive rev%

Maragua DH205880031739.6154.7125819215.3126.3

Kandara Hc207755710418.743.8152021013.821.0

Sabasaba HC102445326758.972.657110718.721.9

Kigumo HC7022956221.011.6407215.200.0

Makuyu HC154853316430.863.71015313.100.0

Kangari Disp98632617954.9105.6660416.200.0

Muthithi Disp39718812868.100.020913866.000.0

Kambiti Disp65227713448.453.737512332.810.8

Mugumoini Disp3251249274.200.020110.500.0

Kagumoini Disp34014911073.865.5191168.4212.5

NgurweiniDisp215561628.600.015900.000.0

Maragua R. D.53181477.800.035617.1116.7

Gikoe Disp3041392417.300.0165159.100.0

Kariua Disp2131061514.216.71071514.000.0

Kamahuha Disp1249555.300.02900.000.0

Githunguri Disp153886270.500.06534.600.0

Kanderendu Disp102441227.300.0581627.616.3

Naaro Disp136503060.000.0862023.300.0

Mutheru Disp139573459.625.9821113.400.0

Muruka Disp3471462416.400.02013014.900.0

Kariti Disp3251224032.800.020310.500.0

Gaichanjiru .M.H126321031.300.09477.400.0

Githumu M.H209543870.425.315563.900.0

A.I.C.Mununga D84271244.4216.757915.800.0

Total126394736189340.0613.27903101912.9212.1

Sheet2

Sheet3

PMTCT+ cascade of interventions. Situation in Maragua in January- June 2005

P

Pregnant

Pre-test counselling

Test accepted

ANC + CD4 count + WHO stage

ARV (Prophylaxis or HAART)

Delivery in a health facility

Safe infant feeding

ANC

HIV positive

General Objectives on progress

DHMT meeting in June 2005

Challenges identified in comprehensive care for pregnant women and their families:

Access to HIV testing: Only 40% of pregnant women (1893 out 4736) are tested for HIV in the 24 ANC clinics in the District. Few ANC nurses trained as HIV counselors and able to prescribe ARV (stigma is also with the Health care worker).

2.Access to HIV comprehensive care: Only 14 out of 82 HIV + pregnant women were registered in comprehensive care clinic (83% of drop out) , 8 had a CD4 done (9%), 4 received HAART (4.8%). No clinicians in MCH department. Women droped out from the referral system. No PSS.

3.No M&E system in place to trace mothers sequentially (seen in various departments during pregnancy, delivery, breastfeeding).

4.Infant formula was not available in the MoH system. Early diversification is the cultural norm.

5.No viral tests to monitor overall impact of the intervention.

83%17%

Action plan (June 05) Vision: An HIV free generation by the end of 2006

Motto: As simple as possible with minimal input and maximal output.

Training of nurses from MCH in DTC and HAART.

Employment of 9 more staff in an initial phase, 12 in a second phase (MoH contracts).

Group pretest counseling and Opt out instead of Opt in strategy.

Visual teaching aids (flannel graphs) to facilitate understanding of the disease.

A vehicle to cover West part of the District on Wednesdays and East part on Thursdays to collect all CD4 samples so pregnant women are not referred to central lab.

MCH Nurses to manage women in WHO stage I and II with more than 350 CD4 (prophylaxis with ZDV and NVP). Stage III or IV and CD4

All pregnant women encouraged to attend ANC in a health facility as soon as possibleAll pregnant women booking ANC services in a Health facility (levels 2,3,4,5 and 6) are offered HIV testing (opt-out)To all HIV infected pregnant women: computerized file opened, counselling, WHO staging, CD4 count, antenatal profile, LLITN, support groups for every 20 mothers, M2M, NHIF card, nutrition supportAll HIV infected pregnant women: encouraged to deliver in the hospital, free deliveries for mothers with no NHIF card, mothers on HAART to continue, mothers on AZT receive SD-NVP. All exposed infants SD-NVP + AZT. Intensive counselling for all mothers, especially those tested intrapartum (M2M).CD4 count < 350: HAART, prophylaxis and treatment of OI

CD4 count > 350: AZT from 28 weeks, prophylaxis and treatment of OI. SD-NVP adding (AZT+3TC for 3 days)Mothers who opt TO breastfeed

Exclusive breastfeeding (EBF) for 6 months or as long as the mothers can manage, then supported weaning with infant formula, counselling and safe water kit. Supply of infant formula up to 1 year of age then discharged Computerized file opened with multiple variables DNA-PCR at 6 weeks and before stopping EBF If still BF at 9, 12 and 18 months antibody test if HIV positive DNA-PCR to confirm (national protocol). CD4 count every 6 months and WHO staging for mother and HAART as per national guidelines Treatment and prophylaxis of OI for mothers Cotrimoxazole prophylaxis for infants up to confirmed HIV negative result Family planning Counselling on: disclosure, partner involvement, safe infant feeding, on-going counselling Support groups (for every 20 mothers as per Karatina model) Nutritional support Infants with HIV positive results assessed for OI and HAART Immunizations and follow up in the MCH clinic (under 5) as per national guidelines (including vit A and multivit).Mothers who opt NOT to breastfeed: Mothers provided with safe water kit and infant formula during last trimester of pregnancy and up to 1 year of age then discharged Computerized file opened with multiple variables DNA-PCR at 6 weeks, if HIV negative confirmatory test at 9 m (according to national protocol). CD4 count every 6 months and WHO staging for mother and HAART as per national guidelines Treatment and prophylaxis of OI for mothers Cotrimoxazole prophylaxis for infants up to confirmed HIV negative result Family planning Counselling on: disclosure, partner involvement, safe infant feeding, on-going counselling Support groups (for every 20 mothers as per Karatina model) Nutritional support Infants with HIV positive results assessed for OI and HAART Immunizations and follow up in the MCH clinic (under 5) as per national guidelines (including vit A and multivit)P R E G N A N C YDELIVERY I N F A N T F E E D I N GModel of care for pregnant women living with HIV and their infants

EPI, < 5 yrsGroup counseling and HIV testingANC, clinical care, individual counselling, IEC, replacement feeding, HAART, blood removal, clinician on callFamily planning4 mtr.Integration of HIV care services in MCH department in the District HospitalMCH is a department run by nurses, if HIV positive pregnant and postnatal mothers are not to be referred to the HIV clinic, a clinician on permanent basis or on call is required

HIV testing uptake in ANC for first visit pregnant womenDistrict Hospital

Safe water Kit85% of mothers opted for using a feeding bottle despite of being counselled on the cup, (n=99)Mugo et al, TUPEB107 Sydney 2007 IAS ConferenceMethods: What makes replacement feeding safe in areas with limited resources?

ResultsInfants of HIV+ mothers followed in MCH clinic n=217Infants initiated on RF at birth n=146

Postnatal enrolment:19 infants from CM to RF16 infants from BF to RFMean duration CM: 23 daysMean duration BF: 31 days48 infants still active at the time of the analysisMean follow-up: 86 daysDNA-PCR results available: 9No HIV+ results127 infants dischargedMean duration RF: 143 daysDNA-PCR results available: 1091 HIV+ result (0.9%)Total infants initiated on RFN=181Total infants receiving RF n=1753 infants defaulted3 infants died (2 HIV+)Figure 1. Replacement feeding program cohort profile, Maragua District Hospital

CM=cows milk, BF=breast fed, RF=replacement feeding

Replacement feeding program in Karatina DistrictDistribution according to support groups. Period Sept 06 May 08

No aditional human resources needed in this program85% of HIV infected mothers opted not to breastfeed their infants59% of partners support RF. Since April 2007 no new HIV infections.

Diagramm1

316120

313402

216200

018200

018121

017200

091100

031530

HIV +ve

HIV -ve

Unknown

Deaths

Defaulters

Group A

KARATINA HOME BASED CARE - PMTCT+

DischargedGroupDateNameAge(yrs)MCH NoCCC noReferral fromResidenceNew or RevisitAntenatal or PostnatalLMPEDDGestational age(wks)WHO StageCD4 CountDate CD4 doneGestational age of CD4(wks)Hb (g/dl)HAART(Write regimen)Date start HAARTProphylaxis(AZT,NVP) - MotherDate start prophylaxisSeptrin prophylaxisAdherenceDate of deliveryDelivery in health facility y/nProphylaxis(AZT,NVP)-BabyPlace of delivery-Home or Health facilityReplacement feeding(RF) or Breastfeeding(B)Number of tinsFeeding bottle y/nThermosWater filterAge of start of RF(wks)Start with?Mixed feeding(Specify)Duration of MF(Days)Defaulter ageBirth Weight(kgs)Wt 1st MoWt 2nd MoWt 3rd MoWt 4th MoWt 5th MoWt 6th MoWt 7th MoWt 8th MoWt 9th MoDiarrhoel dse(episodes)Respiratory diseaseOther dsesPCR ResultDate of PCRAge of PCR(Wks)TCA

Weaned1 A19.02.2007Annet Wanbui GitongaK.D.H.Kirinyaga2Postnatal562YesN/AN/A30.01.2007YAZT, NVPHealth FacilityRF60YYYSince birthRFFormula since birth34.367.299.2PositiveMother had very poor health during birth

Deceased2 A5/11/07Stefanie Wambui Wanjohi6 months348/06K.D.H.MuthuaNewPostnatal255no datano data22-Sep-06Septrin prophylaxis21.08.2006YAZT,NVPHealth FacilityRF61YYYSince birthRFformula since birth3.55.54.25.564.9PositiveBaby succumbed on 25.09.2007

Weaned3 A2/12/07Rose Wanjiru Kirenga6 months2296K.D.H.NdaroiniNewPostnatal140TriviroNov'2006Septrin prophylaxis24.07.2006Ybaby nevirapineHealth FacilityB46YYY02.11.2006BreastfeedingBreastfeeding 3 months3.744.54.7negative01.11.2006Parents separated

Weaned4 A17.03.2007Evon Nyawira6 months1084K.D.H.KaguyuNewPostnatal99315.11.2006Septrin Prophylaxis05.10.2006YAZT,NVPHealth FacilityRF3YYSince birthRFFormula since birth2.545.155.76.16.36.556.746.577.16.967.9NegativeDiscordant couple

Weaned6 A03.09.2007Hope Muthoni Wangechi6 monthsK.D.H.GacharuNewPostnatal295Triviro12.08.2007YAZT,NVPHealth FacilityRF2YYSince birthRFFormula since birth2.7Negative

Weaned7 A03.09.2007Douglas Warui Maina6 monthsK.D.H.KarindunduNewPostnatal300Triviro18.07.2006Septrin Prophylaxis20.07.2006YAZT,NVPHealth FacilityRf86YYSince birthRFFormula since birth3.556.647.857.9Positive

Weaned8 A06.06.2007Collins Mwago Kabugu6 months8935K.DH.MiiriNewPostnatal818No04.10.2006Septrin Prophylaxis11.06.2006YAZT,NVPHealth facilityRF50YYYSince birthRFformula since birth3.54.95.76.28.67.3negativeDiscordant couple

Weaned9 A0.309.2007Margaret Wagithi Mwangi6 monthsK.D.H.KiawarigiNewPostnatal100YesSeptember' 2007Septrin prophylaxis20.09.2006YAZT,NVPHealth FacilityRF2YYSince birthRFformula since birth33.44.25.7Negative

Weaned10 A19.09.2007Veronica Waithera Ngari6 monthsK.D.H.KiamwangiNewPostnatal24014.08.2007YAZT,NVPHealth facilityRF43YYY1.11.2006RFformula since birth33.56.27.1Negative

Defaulter11A11.07.07Anthony Njuki6 months1187K.D.H.InonoNewPostnatalSeptrin Prophylaxis01.04.2007YHealth facilityB3Y3 months after birthBreastfeedingFormula milk 3 months after breastfeeding3 months3.54.65.25.8NegativeFather not tested

Weaned12 A5/3/07David Mugwe Huria6 months18077K.D.H.RagatiNewPostnatal153TriviroYesSeptrin prophylaxis29.07.2006Ybaby nevirapineHealth FacilityRF58YYY14.05.2007BreastfeedingBreastfed for 2 months3.65.266.47.38.8negative30.11.2006Mother deceased

Weaned13 A06.02.2007Anne Wanjiru Maina6 months248K.D.H.KarindunduNewPostnatal813Septrin prophylaxis31.07.2006Ybaby nevirapineHealth FacilityRF59YYYSince birthRFBreastfed for 3 months4.56.55.86.5negativeDiscordant couple

Weaned14 A3/1/07Stephen Maina Muriithi6 months2801K.D.HKirimukuyuNewPostnatalno dataYes29.08.2006Nno dataHealth FacilityRF37YYY07.11.2006Cows milkCows milk for 2 months2.32.83.5Negative

Weaned15 A28.12.2006Joseph Kinyua Muriithi6 months3748K.D.H.NganduNewPostnatal420Sept'2006Septrin Prophylaxis01.08.2006YAZT,NVPHealth FacilityRF47YYY07.11.2006BBreastfeeding for3 months3.55.256.47.3NegativeDiscordant couple

Weaned16 A23.05.2007Jotham Mwai Waruguru6 months18633K.D.H.KarindunduNewPostnatal167Triviro10.10.2006Septrin prophylaxis30.10.2006YHealth FacilityRF56YYYSince birthRFFormula since birth24.55.8NegativeDiscordant couple

Weaned17 A29.05.2007Lufas Kiraitai Mugo6 months18410K.D.H.KiamabaraNewPostnatal45218.07.2006Septrin Prophylaxis29.09.2006Ybaby nevirapineHealth FacilityRF52YYYSince birthRFformula since birth13.75.55.86.36.456.5Negative

Deceased18 A29.05.2006Erick Kabiru6 monthsChild died before having the PCR test

Weaned19 A6/5/07Charles Njuki Waithera6 months3585K.D.HKinyakiiruNewPostnatalN/A06.09.2006Yno dataRF45YYYSince birthRFno breastfeeding3.13.54677.57negativeMother deceased

Postive3

Negative16

No results1

Deaths2

All weaned

l

Tanja:Analysis done on June 5th

Tanja:Last consultation for the discharged

Group B


DischargedGroupDateNameAge(yrs)MCH NoCCC noReferral fromResidenceNew or RevisitAntenatal or PostnatalLMPEDDGestational age(wks)WHO StageCD4 CountDate CD4 doneGestational age of CD4(wks)Hb (g/dl)HAART(Write regimen)Date start HAARTProphylaxis(AZT,NVP) - MotherDate start prophylaxisSeptrin prophylaxisAdherenceDate of deliveryDelivery in health facility y/nProphylaxis(AZT,NVP)-BabyPlace of delivery-Home or Health facilityReplacement feeding(RF) or Breastfeeding(B)Number of tinsFeeding bottle y/nThermosWater filterAge of start of RF(wks)Start with?Mixed feeding(Specify)Duration of MF(Days)Defaulter ageBirth Weight(kgs)Wt 1st MoWt 2nd MoWt 3rd MoWt 4th MoWt 5th MoWt 6th MoWt 7th MoWt 8th MoWt 9th MoDiarrhoel dse(episodes)Respiratory diseaseOther dsesPCR ResultDate of PCRAge of PCR(Wks)TCARemarks

Weaned1 B15.01.2007Paul Miano Mugo6 months137K.D.H.GitundutiNewPostnatal225Triviro2006 NovemberSeptrin prophylaxis16.11.2006YAZT,NVPHealth FacilityRF50YYY22.11.2006RFCows milk for 6 days3.54.65..87.9negative

Traced2 B16.04.2007Maxwell Maina Gikere98/04K.D.H.KarindunduNewPostnatalSeptrin prophylaxis13.04.07YHealth FacilityRF3YYSince birthRFformula since birth33.54.755.35.95PositiveDoubles up as a defaulter

Weaned3 B12.06.2007Kennedy Karuku Nyambura18818K.D.H.GateiNewPostnatalSeptrin prophylaxisNo data

Traced4 B05.02.2007Mary Kanini Gitahi1 month237K.D.H.Ragati - Kimaru'sNewPostnatalSeptrin Prophylaxis14.07.2006Health FacilityRF15YYYSince birthRFmother refused to come after being traced2.83.14.65.2Negative30.11.2006no data

Weaned5 B07.03.2007Lincon Machira Kwengu3321K.D.H.KarindunduNewPostnatal3361st December 2006Septrin prophylaxis06.11.2006YAZT,NVPHealth FacilityRF3YYYSince birthRFBreastfed for 1 month3.85.36.37.47.78.4Positive

Weaned6 B5/5/07Simon Kariuki Kiige6 months3242K.D.HNdimainiNewPostnatal457Nov'2006Septrin Prophylaxis31.12.2006NHealth FacilityRF56YYY16.11.2006BreastfeedingBreastfeeding for 2 weeks2.63.55.25.5Negative

Weaned7 B13.11.2006Monicah Wanjiru Mwangi6 months2989K.D.H.KiaruhiuNewPostnatalNoNo data05.12.2006YHealth FacilityRF52YYYSince birthRFBreastfed for 2 months35.55.86.36.46.5PositiveChild on CPT

Weaned8 B25.05.2007Liza Marie Wairimu18653K.D.H.MuruguruNewPostnatal367Nov-06Septrin prophylaxis05.12.2006YHealth FacilityRF2YYSince birthRFFormula since birth3.8566.57.3no data

Traced9 B04.05.2007Maureen Njeri Kariithi18430K.D.H.GaturaNewPostnatal429Yes08.11.2006Septrin prophylaxis11.12.2006YHealth FacilityRF2YYSince birthRFformula since birth3.64.24.46.37.257.6Negativebaby came last in June

Weaned10 B12.03.2007Mercy Wangui Maina20979K.D.H.MathaithiNewPostnatal202Septrin prophylaxis24.12.2006YHealth FacilityRF3YY4 days after birthRFBreastfed for 4 days2.84.35.15.566.56.56.9Negative07.07.2007

Weaned11 B22.01.2007Samuel Munene MainaK.D.H.KiganjoNewPostnatal905Septrin prophylaxis30.12.2006YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth4.25.35.96.97.27.57.7Negative

Weaned12 B19.09.07Victor Muchai WanjauK.D.H.KiamabaraNewPostnatal498Nov'06Septrin prophylaxis13.01.2007YAZT,NVPHealth facilityYYSince birthRFformula since birth3.55.56Negative

Weaned13 B15.05.2007Caleb Maina Ndirangu18500K.D.H.KiburuNewPostnatal78824.01.2007Septrin prophylaxis22.01.2007Ybaby nevirapineHealth FacilityRF2YYYSince birthRFformula since birth3.54.86.27.17.28.28.49negativediscordant couple

Weaned14 B21.04.2006Mike Murimi Maina6 months1715K.D.H.KibingotiNewPostnatal445Dec-06Septrin prophylaxis18.01.2006Yno dataHealth FacilityRF50YYYSince birthRFformula since birth3.75.27.38.59.4510.2NegativeChild on CPT

Weaned15 B2/1/07Peris Njoki Kibui6 months2274K.D.H.GithiNewPostnatal48319.01.2007Septrin prophylaxis27.12.2006Ybaby nevirapineHealth FacilityRF59YYY6.11.2006RFformula since birth44.35.56.5NegativeDiscordant couple

Weaned16 B26.06.2007Julius Mwaura NyoikeK.D.H.KirinyagaNewPostnatal21.11.2006YAZT,NVPHealth facilityRF2YSince birthRFFormula since birth2.84.4Negativediscordant couple

Weaned17 B06.02.2007Joyce Waruguru Maina6 months72K.D.HKiagotheNewPostnatal308Yesno dataDec' 06Septrin Prophylaxis02.02.2006Ybaby nevirapineHealth FacilityRF51YYYSince birthRFformula since birth2.84.455.15.86.46.87.1NegativeDiscordant couple

DefaulterE3.09.2007Denis Maina Macharia1892K.D.HKirinyagaNewPostnatalyes21.03.2007Septrin prophylaxis30.05.2007YNVPHealth FacilityRF2YY2 monthsBF3.24.35.2Defaulted before having the PCR

Weaned19 B3/22/07Monicah Wanjira Hiuhu6 months15669TumuTumuItunduNewPostnatal216TriviroAug'06Septrin prophylaxis26.01.2007Ybaby nevirapineHealth FacilityRF49YYYSince birthRFformula since birth3.557.47.7No data

Weaned20 B26.02.2007Caroline Wanjira Mwangi17796K.D.H.IhwagiNewPostnatal47421.11.2006Septrin prophylaxis05.02.2007YAZT,NVPHealth FacilityRF3YYYSince birthRFformula since birth2.73.855.56.77.188.359.3Negative

Positive3

Negative13

No results4

Defaulters2

All weaned



Group C



Weaned1 C27.01.2007Solomon Githinji Maina6 monthsK.D.H.SaganaNewPostnatal1187no dataSeptrin prophylaxis12.01.2007Nbaby nevirapineHealth FacilityRF39YYY2.02.2007Cows milkBreast fed for 3 weeks3.866.36.88.287.75Negative

Weaned2 C03.09.2007Ian Maina Kariuki6 months76K.D.H.MweaNewPostnatal37025.04.2007NVPSeptrim prophylaxis06.02.2007No dataHealth FacilityRF2YYSince birthRFFormula since birth3.54.67.18.78.88.989.4Negative

Weaned3 C18.05.2007Diana Wamaitha Thamaini6 months18683K.D.H.MagutuNewPostnatalSeptrin Prophylaxis30.01.2007YAZT,NVPHealth FacilityRF2YYSince birthRFFormula since birth2.53.1845.15.25.25Negativediscordant couple

Weaned4 C28.05.2007Dorcas Wakina Maina6 monthsK.D.H.RagatiNewPostnatal497Jan-07Septrin Prophylaxis08.01.2007YAZT,NVPHealth FacilityBF2YY22.02.2007RFBreastfed for 6 weeks34.75.75.8556.45.66.56.7PositiveCouple on ART

Weaned5 C18.04.2007Ian Maina Karimi6 months1279K.D.H.KerugoyaNewPostnatal246Trio LNSFeb-07Septrin Prophylaxis24.02.2007YAZT,NVPHealth FacilityRF3YYYSince birthRFformula since birth34.75.76.357.27.57.658Negative

Weaned6 C08.05.2007Esther Wanjiru Kabuga6 months321K.D.H.KarindunduNewPostnatal39522.02.2007Septrin prophylaxis06.02.2007YAZT,NVPHealth FacilityRF49YYYSince birthRFFormula since birth1.63.14.74.725.155.65.75.96NegativeDiscodant couple

Weaned7 C31.05.2007Joseph Maina Karobia6 months9043K.D.H.Kabaru - Kieni eastNewPostnatal296YesAug'2006Septrin Prophylaxis22.02.2007YAZT,NVPHealth FacilityRF201.03.2007RFFormula since birth4.45.56.47.2Negative

Weaned8 C21.03.2007Shadrack Warutere Mwai6 monthsK.D.H.Sagana schemeNewPostnatal1150Yes2005no dataSeptrin Prophylaxis02.03.2007YAZT,NVPHealth facilityRF36YYY06.12.2006RFformula since birth4.14.75.46.756.36.76.8Negative

Weaned9 C13.03.2007Charity Muthoni Gathekia6 months90/07K.D.H.KarindunduNewPostnatal345YesSeptrin prophylaxis02.03.2007YNVPHealth FacilityRF3YY1Since birthRFFormula since birth2.84.55.356.856.87.3NegativeDiscordant couple

Weaned10 C22.01.2007Shadrack Muriuki Mwangi6 months2128K.D.H.MathaithiNewPostnatal358no datano dataSeptrin prophylaxis06.03.2007YAZT,NVPHealth FacilityRF20YYYSince birthRFFormula since birth3.85.36.37.47.78.49No data20

Weaned11 C6/4/07Christine Wairimu Njeri6 months9032K.D.H.Mbogo-iniNewPostnatal590no data06.05.2007Septrin Prophylaxis06.03.2007YAZT,NVPHealth FacilityRF2YYSince birthRFFormula since birth3.545.56.46.87.27.65NegativeMay-07Discordant couple

Weaned12 C26.03.2007Chris Githinji Maina6 months18074K.D.H.KarindunduNewPostnatal614Septrin prophylaxis16.03.2007YAZT,NVPHealth FacilityRF3YYSince birthRFFormula since birth2.854.295.185.58678.05NegativeDiscordant couple

Weaned13 C30.06.2007Juliet Waraiciri Kariuki6 monthsK.D.H.Thigirici - NdiaNewPostnatal641Septrin Prophylaxis29.06.2007YAZT,NVPHealth facilityRF5YSince birthRFFormula since birth2.834.95Negative

Weaned14 C5/31/07Charity Wambui Njeri6 months18528K.D.H.KiamarigaNewPostnatalTrio LNS5/12/07baby nevirapineHealth Facility3YY15.05.2007RFFormula since birth3.74.494.85.5negative24.7.2007discordant couple

Weaned15 C16.05.2007Maxwell Weru Njukia6 months18537K.D.H.Kirimukuyu - ThaithiNewPostnatal338YesSeptrin prophylaxis22.03.2007NAZT,NVPHealth facilityRF3yYYSince birthRFformula since birth3.54.85.66.377.9NegativeDiscordant couple

Weaned16 C27.10.2006Mary Wairimu Giatui6 monthsK.D.H.KerugoyaNewPostnatal612Feb-07Septrin prophylaxis22.02.2007YAZT,NVPHealth facilityRFSince birthRFformula since birthno data3.65.26.57.489.1negative

Weaned17 c6/5/07Samuel Ngugi Maina6 months2321K.D.H.KiarithainiNewPostnatal235no datano data06.12.2006Septrin prophylaxis26.02.2007YAZT,NVPHealth facilityRF51YYSince birthRFformula since birth3.75.56.788.25Negative08.06.2007she has not disclosed

Traced18 C05.02.2007Isaac Mwangi Kamau6 months220K.D.H.Iria-iniNewPostnatal308Dec-06Septrin Prophylaxis2/2/07Ybaby nevirapineHealth FacilityRF55YYSince birthRFformula since birth2.84.45.15.56.87.1Defaulted before having PCRParents decided to feed baby on goats milk

Weaned19 C06.12.2007Jeff Karume Kimata6 months3533KDHWarirutaNewPostnatal873Septrin prophylaxis17.04.2007YAZT,NVPHealth FacilityRF34YYYSince birthRFformula since birth3.43.94.955.856.56.87.58.7Negative

Traced20 C22.02.2007Defather Ngure Gachihi6 months28/07K.D.H.KiamuthangaNewPostnatal497Septrin Prophylaxis08.01.2007YAZT,NVPHealth FacilityRF3YYYBreastfeedingBreastfed for 6 weeks6 weeks34.75.45.85PositiveTracing done, parents separated - Mother left for Samburu

Positive2

Negative16

No results2

Defaulters & Traced2

All weaned



Group D



Weaned1 D26.04.2007Miguel Njue Nyaga6 monthsK.D.H.GiakairuNewPostnatal48Yes28.02.2007Septrin prophylaxis18.04.2007YAZT,NVPHealth FacilityRF45YYSince birthRFformula since birth4.65.56.67.78.58.959.35negative

Weaned2 D15.02.2007Venesa Mumbi Waigwa6 months1414K.D.H.KahuruNewPostnatal462Mar-07Septrin prophylaxis30.04.2007Yno dataHealth FacilityRF43YYYSince birthRFformula since birth2.73.644.595Negative

Weaned3 D19.09.2007Wycliff Wambugu KahuhiK.D.H.KarindunduNewPostnatalNo data12.02.2007YAZT,NVPRFYYCows milk for 3 monthsRFformula since birth2.32.43.54.4555.5Negative

Weaned4D09.06.2007Helen Njeri Muriithi18803K.D.H.KarogotoNewPostnatal185YesSeptrin Prophylaxis05.05.2007YAZT,NVPHealth facilityRF9YYSince birthRFformula since birth22.33.53.64.55.4NegativeFather's CD4 763 - on CPT

Weaned5D03.09.2007Jeff Kariuki NyagaK.D.H.KiarithainiNewPostnatal455YesSeptrin prophylaxis11.05.2007YAZT,NVPHealth FacilityRF2YYSince birthRFFormula since birth44.95.676.4266.7Negative26.07.2007Discordant couple

Weaned6 D03.09.2007Kelvin Munuhe Maina1808K.D.H.KiamarigaNewPostnatal54YesSeptrin prophylaxis12.05.2007YAZT,NVPHealth FacilityRF2YYSince birthRFformula since birth3.74.494.855.56.2Negative24.07.2007Discordant couple

Weaned7 D02.03.2007Cynthia M. Nyaguthi Njuguna6 months941K.D.H.SaganaNewPostnatalTrivioSeptrin prophylaxis02.03.2007Ybaby nevirapineHealth FacilityRF3YYYSince birthRFformula since birth4.14.75.46.76.36.7Negative

Weaned8D24.02.2007Brian Murimi Maina17816K.D.HKiburuNewPostnatal02.04.2007YHealth FacilityRF3YY15.05.2007Cows milkCows milk2.61.93.54.735.35.47NegativeCouple on ART

Re-located9 D16.03.2007Mary Wairimu Wangeci6 months18068K.D.H.Tumu TumuNewPostnatal56717.12.07Septrin prophylaxis16.03.07YAZTHealth FacilityRF3YYSince birthRFFormula milk since birth3.74.85.5Results to be tracedMother re-located

Weaned10D14.05.2007Boniface Ndungu Njoroge18496K.D.H.GithimaNewPostnatal150YesSeptrin Prophylaxis27.04.2007YBaby zidovudineHealth FacilityRF3YYYSince birthRFformula since birth2.244.55.3Awaiting results

Weaned11 D06.03.2007Ezekiel Ndiu Murage983K.D.H.KibingotiNewPostnatal52329.05.2007Septrin prophylaxis16.05.2007YAZT,NVPHealth FacilityRF3YYYSince birthRFformula since birth4.25.367.188.5NegativeApril '07Discordant couple

Weaned12 D16.05.2007Charles Maina Murimi17763K.D.H.IriainiNewPostnatal158Septrin prophylaxis04.05.2007Ybaby nevirapineHealth FacilityRF4YYSince birthRFformula since birth3.75.36.17.17.78.5negativeCouple on Septrin prophylaxis

Weaned13 D6/4/07Nancy Wangari Kamotho6 monthsno dataK.D.H.GatituNewPostnatal367NoSeptrin prophylaxis10.03.2007Yno dataHealth FacilityRF71YYYSince birthRFformula since birth3.74.24.65.15.65.86.46.6negative

Weaned14 D15.03.2007Miriam Wanjiru Muriithi6 months156154K.D.H.NdaroiniNewPostnatal543no datano dataSeptin prophylaxis23.05.2007YHealth FacilityRF71YYYSince birthRFformula since birth3.64.55.87.4negativeChild on CPT

Weaned15 D23.01.2007Ann Prudence W. Mathenge5 months212K.D.H.RagatiNewPostnatal50YesSeptrn prophylaxis25.05.2007YAZT,NVPHealth FacilityRF73YYYSince birthRFformula since birth3.64.16.27.27.28.2negative15.05.2007Father on ART, Mother on CPT

Weaned16 D3/1/07Silvia Nyaguthii Wandia6 monthsK.D.H.GaturaNewPostnatal729Sep '07no datano dataSeptrin prophylaxis25.05.2007YHealth facilityRF61YYY27.10.2007formula since birth3.955.56.196.3YYNegative

Weaned17 D27.02.2007Beatrice Wangui Muthoni17798K.D.HKarindunduNewPostnatal945Septrin prophylaxis29.05.2007YAZT,NVPHealth FacilityRF3YYSince birthRFformula since birth3.34.55.286.16.4NegativeDec '06Discordant couple

Weaned18 D12.06.2007Alex Maina Mbuthia1818K.D.H.KirimukuyuNewPostnatal469NoSeptrin Prophylaxis18.05.2007YAZT,NVPHealth FacilityRF10YYSince birthRFFormula since birth245.15.956negativeDiscordant couple

Weaned19 D31.05.2007Fidelis Wangeci Kinagu4 months3238K.D.H.JamboNewPostnatal613Septrin Prophylaxis30.05.2007Ybaby nevirapineHealth FacilityRF2YY15.05.2007formula since birth2.53.64.34.935.5NegativeDiscordant couple

Weaned20 D15.03.2007Michael Mugambi Macharia6 monthsno dataK.D.H.KarindunduNewPostnatal679Trivirono data6-NovSeptrin prophylaxis14.04.2007Yno dataHealth FacilityRF60YYYSince birthRFformula since birth34.367.299.2Negative

Positive0

Negative18

No results2

Defaulters0

Relocated1

All weaned



Group E



Weaned1 E01.12.2007Naomi Mumbi Muchemi6 months2886K.D.H.MukaroNewPostnatal333no datano data18.03.2007Septrin Prophylaxis15.03.2007YAZT,NVPHealth FacilityRF57YYYSince birthRFformula since birth34.55.55.66.5Negative

Weaned2E30.06.2007Fidelis Wanjiru Githinji6 months1803K.D.H.Mukurwe-iniNewPostnatal57524.04.2007Septrin Prophylaxis09.06.2007YAZT,NVPHealth facilityRF2YYSince birthRFFormula since birth3.53.654.575.256NegativeMother on ART, Father on CPT

Weaned3 E3/1/07RoseAngel Gathoni6 months2231K.D.H.NganduNewPostnatal537TriviroSeptrin prophylaxis29.05.2007YAZT,NVPHealth FacilityB58YYY2.11.2006RFformula since birth3.44.755.46.71Negative

Weaned4 E08.02.2007Brian Thuo Njoki6 months264K.D.HMukurwe-iniNewPostnatal491Septrin prophylaxis12.06.2007Ybaby nevirapineHealth FacilityRF3YYSince birthRFFormula since birth4.75.67.28.59.4Negative24.07.2007

Weaned5 E26.02.2007Mercy Njoki Wanjohi6 months906K.D.H.MuthuaNewPostnatal192Septrin prophylaxisYAZT,NVPHealth FacilityRF3YYSince birthRFformula since birth3.75.56.788.2Negative19.10.2007

Weaned6 E17.06.2007Job Mwari Kaburu6 months18268K.D.H.MuthuaNewPostnatal220Septrin prophylaxis16.06.2007YAZT,NVPHealth facilityRF5YYSince birthRFFormula since birth3.53.94.8NegativeFather not tested

Weaned7 E17.05.2007Bilha Nyokabi Wambui6 months18553K.D.H.MiiriNewPostnatal1010Septrin prophylaxis24.06.2007YAZT,NVPHealth FacilityRF2YSince birthRFFormula since birth3.54.55.36.27.7NegativeNov-07Discordant couple - Separated

Weaned8E12.02.2007Cynthia Wambui Mwangi6 monthsK.D.HTumu TumuNewPostnatal781Septrin prophylaxis29.06.2007Yno dataHealth FacilityB3YYSince birthRFFormula since birth3.53.354.76.5NegativeDiscordant couple - Father positive

Weaned9E2/12/07Morgan Maina Mwangi6 months2106K.D.H.NdimainiNewPostnatal595no datano dataSeptrin prophylaxis29.06.2007Yno dataHealth FacilityRF15YYYSince birthRFformula since birth34.955.957.2Negative18

Deceased10E28.12.2006Moses Kibuga Gathimba6 months48K.D.H.Mukurwe-iniNewPostnatal483no data19.01.2007Septrin Prophylaxis27.12.2006Ybaby nevirapineHealth FacilityRF44YYY23.01.2007RFformula since birth44.35.56.5NegativeDiscordant couple. Baby died of pneumonia on 26.10.07

Active11E29.05.2007Emmaculate Mumbi Gachari18702K.D.H.MukurweiniNewPostnatal94529.05.2007YAZT,NVPHealth FacilityRF2YYSince birthRFFormula since birth3.34.65.3Negative

Deceased12E28.05.2007Agatha Wanjiku Gatura3 months18156K.D.H.KibingotiNewPostnatalN/AN/AN/A02.04.2007Ybaby nevirapineHealth FacilityRF3YYY15.05.2007Breastfeedingbreastfeeding 2 weeks cows milk 2 weeks1 month1.92.63.53.64.8Died before having taken the testBaby succumbed to chest infection

Weaned13E25.06.2007Abraham Njau Gichimu6 months18312K.D.H.KirinyagaNewPostnatal202TriviroSeptrin prophylaxis30.05.2007Ybaby nevirapineHealth FacilityRFBreastfed for 2 months3.24.35.25.25.16.253 monthsNegative12.11.20076Discordant couple

Active14E25.05.2007Jeff Wanjohi Muruthi5 monthsK.D.H.KaruraNewPostnatal639Septrin Prophylaxis07.08.2007YAZT, NVPHealth FacilityRFSince birthRFFormula since birth3.95.16Negative

Active15 E5/4/07Hellen Nduta Mwangi18704K.D.H.GitituNewPostnatal30012.08.2007Septrin Prophylaxis12.08.2007YAZT, NVPHealth FacilityRF2YYSince birthRFformula since birth2.73.85NegativeDiscordant couple

Active16 E19.09.2007William Muriuki MwangiK.D.H.MukuiNewPostnatal155May-07Septrin prophylaxis17.08.2007YAZT,NVPHealth facilityRFYYSince birthRFformula since birth3.954.65Negative

Active17E29.05.2007Kevin Munene Ndiangui18747K.D.H.JamboNewPostnatal410Apr-07Septrin Prophylaxis15.08.2007YAZT,NVPHealth facilityRF8YYSince birthRFformula since birth3.64.555.56.47Negative

Active18E02.03.2007Anne Wanjiru MwangiK.D.H.GachuiroNewPostnatal656YesTriviroJun-07Septrin prophylaxis26.05.2007YAZT,NVPHealth FacilityRF3YYSince birthRFformula since birth2.84.55.36.86.87.3Negative

Active19 E3/1/07Samuel Gathambu Macharia6 monthsK.D.H.ItiatiNewPostnatal763YesSeptrin prophylaxis29.08.2006YAZT,NVPHealth FacilityB37YYYSince birthRFformula since birth3.94.24.57Negative14/12/20068

Relocated20E18/12/07John Kariuki Karaba

Positive0

Negative18

No results1

Defaulters1

Relocated1.

Deaths2



Group F



Active1F4/10/07MarkVincent Muriithino dataK.D.H.KerugoyaNewPostnatalno dataD4T-3TC-NVPno data02.07.2007Septrin prophylaxis28.08.2007YAZT,NVPHealth FacilityRF50YYYSince birthRFformula since birth3.54.65.5Negative9.10.2007baby defaulted at 4 months

Active2 F02.05.2007Francis Maina WaruiKDHMukurweiniNewPostnatal79Yes08.06.2007Septrin prophylaxis31.08.2007YAZT,NVPHealth FacilityRF1YYSince birthRFformula since birth4.24.355.75Negative

Active3 F25.01.2007Morgan Mugo WambuiK.D.H.KiangwaciNewPostnatal102YesJuly '07Dapson29.08.2007YAZT,NVPHealth FacilityRF75YYYSince birthRFformula since birth2.733.59.45NegativeFather on ART, Mother on CPT

Active4 F13.11.2006MarkEric Mwangi Chege21111K.D.H.KerugoyaNewPostnatal186TriviroMay-07Septrin prophylaxis18.08.2007YAZT,NVPHealth FacilityRF5YYSince birthRFformula since birth22.273.8NegativeMother on ART

Active5 F18.10.2007Joshua Ngaru MuthambukiK.D.H.KiamwangiNewPostnatal393No dataMay-07Septrin prophylaxis20.09.2007YAZT,NVPHealth facilityRFYSince birthRFformula since birth2.64.155.36.2NegativeDiscordant couple

Active6F18.10.2007Milka Wangui KamauK.D.H.KamatuNewPostnatal49213.07.2007Septrin prophylaxis13.09.2007YAZT,NVPHealth facilityRFYYSince birthRFformula since birth2.9NegativeSpouse not tested

Active7F18.10.2007Kellen Nyaguthii MuhiuK.D.H.KagumoNewPostnatal275Yes7-AprSeptrin prophylaxis24.09.2007YAZT,NVPHealth facilityRFYYSince birthRFformula since birth3.1Parents separated

Active8F18.10.2007Daniel Maina KiringaK.D.H.GatikiNewPostnatal293TriviroAug-07Septrin prophylaxisAZT,NVPHealth facilityRFYYSince birthRFformula since birth2.8

Active9F18.10.2007Irene Nyawira MainaK.D.H.Mwea - Stays in SaganaNewPostnatal23.09.2007YAZT,NVPHealth facilityRFYYSince birthRFformula since birth3.6

Active10 F18.10.2007Joseph Maina GathaguK.D.H.KiamarigaNewPostnatal678Yes23.09.2007NAZT,NVPHome deliveryRFYYSince birthRFformula since birth2.7NegativeIst triplet

Active11 F18.10.2007Patrick Mwangi GathaguK.D.H.KiamarigaNewPostnatal678Yes23.09.2008NAZT,NVPHome deliveryRFYYSince birthRFformula since birth2.5Negative2nd triplet

Active12 F18.10.2007Elizabeth Wamuyu GathaguK.D.H.KiamarigaNewPostnatal678Yes23.09.2009NAZT,NVPHome deliveryRFYYSince birthRFformula since birth2.6Negative3rd triplet

Active13 F18.10.2007Edwin Omondi OwinoK.D.H.KarindunduNewPostnatal354Septrin prophylaxis29.09.2007YAZT,NVPHealth facilityRFYYSince birthRFformula since birth3.8NegativeDiscordant couple

Active14 F18.10.2007Joyce Watare WamahiuK.D.H.RuthagatiNewPostnatal525Jun-07Septrin prophylaxis21.09.2007YAZT,NVPHealth facilityRFYYSince birthRFformula since birth4.1Both parents on CPT

Active15 F18.10.2007Pius Kirii WamaeK.D.H.KiamumuNewPostnatal290YesSeptrin prophylaxis30.09.2007YAZT,NVPHealth facilityRFYYSince birthRFformula since birth3.2NegativeSpouse not tested

Active16 F18.10.2007Joyce Nyokabi MathengeK.D.H.KiamwangiNewPostnatal83no dataJuly '07Septrin prophylaxis28.09.2007Yno dataHealth facilityRFYYSince birthRFformula since birth3.4

Re-located17F18.10.2007Grace Wanjugu MarangaYYRe-located to Kieni

Active18 F18.10.2007Caroline Njoki KunyihaK.D.H.KirimaNewPostnatal225YesJun-07Septrin prophylaxis04.10.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.64.755.7Negative

Active19 F18.10.2007Pamela Wanjiru MuthoniK.D.H.KaiyabaNewPostnatal107YesJul-07Septrin prophylaxis07.10.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.44.55.36.1Negative

Active20 F18.10.2007Melvin Waweru NdunguK.D.H.Chema - KibirigwiNewPostnatalHealth FacilityYY3.4Negative

Positive0

Negative14

No results5

Defaulters0

Relocated1



Group G



Active1 G24.10.2007Antonne Sijenyi OnyangoK.D.H.Ndia - KangaitaNewPostnatal311TriviroMar-07Septrin prophylaxis18.10.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.34.4

Active2G31.10.2007Caroline Wanja MwangiK.D.H.KiaraganaNewPostnatalYes26.10.2007Septrin prophylaxis31.07.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.923.14.1Negative

Active3G31.10.2007Ruth Wambui MachariaK.D.H.KiawarigiNewPostnatalYesSeptrin prophylaxis17.10.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.744.755.5

Active4G31.10.2007Nelson Waweru MwangiK.D.H.Narumoru - MwichuiriNewPostnatal324YesSeptrin prophylaxis25.10.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.64.95Negative

Active5G14.11.2007Glory Kageni MugoK.D.H.KirinyagaNewPostnatal332Septrin prophylaxis24.10.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.5Discordant couple

Active6G14.11.2007David Mwai ToronoK.D.H.SophiaNewPostnatal345YesSeptrin prophylaxis03.11.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.9Discordant couple

Active7G14.11.2007Abigael Muthoni MwangiK.D.H.KiangaiNewPostnatalYes08.11.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.9

Active8G14.11.2007Cynthia Wangari KiharaK.D.H.KibingotiNewPostnatalSeptrin prophylaxis11.11.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.8Discordant couple

Active9G14.11.2007Diana Ngima NjeruK.D.H.KiawarigiNewPostnatal80031.12.2007Septrin prophylaxis11.11.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.94.45

Active10 G23.11.2007Patrick Ngari KariukiK.D.H.KihutiNewPostnatal485September '07Septrin prophylaxisYAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.5

Active11 G23.11.2007Peris Mugure IchangaiK.D.H.Ngurubani - KirinyagaNewPostnatal279YesSeptrin prophylaxis09.11.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth2.53.8

Active12 G23.11.2007Nelius Wairimu NdegwaK.D.H.MuthuaNewPostnatal235YesSeptrin prophylaxis21.11.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.25.3Fathers CD4 - 304

Active13 G17.12.2007Venessa Njoki WanjuguK.D.H.MuthuaNewPostnatal275Sep-07Septrin prophylaxis24.11.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.74.7Negative24.01.2008

Active14 G17.12.2007Simon Kinyua KariukiK.D.H.KagochiNewPostnatalSeptrin prophylaxis1.12.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.1

Active15 G17.12.2007Caroline Nyachomba KirituK.D.H.RuthagatiNewPostnatal240YesSeptrin prophylaxis1.12.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.1

Active16 G17.12.2007Gladys Mumbi NgatiaTumu TumuNgoranoNewPostnatal6252003Septrin prophylaxisAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.3Discordant couple

Active17 G17.12.2007Annah Wairimu WanjohiK.D.H.Kamatu - KirimukuyuNewPostnatalYHealth FacilityRFYYSince birthRFFormula since birthDiscordant couple

Active18 G17.12.2007Jane Wanjiku MathengeK.D.H.KahuruNewPostnatal08.12.2007YHealth FacilityRFYYSince birthRFFormula since birth3.1

Active19 G17.12.2007Rita Waithira NjorogeTumu TumuGithimaNewPostnatal51408.10.2007Septrin prophylaxis10.12.2007YAZT,NVPHealth FacilityRFYYSince birthRFFormula since birth3.5Fathers CD4 - 436

Active20 G21.12.2007Levis Muriuki KiringaK.D.H.KiangaiNewPostnatal13.12.2007YAZT,NVPHealth FacilityRFYSince birthRFFormula since birth

Positive0

Negative3

No results17

Defaulters0

Relocated0



summary

GroupABCDEFGH

HIV +ve33200000

HIV -ve16131618181793

Unknown1422121115

Deaths20002003

Defaulters02001000

summary

HIV +ve

HIV -ve

Unknown

Deaths

Defaulters

Group H



Deceased1 H20.12.2007Geoffrey Wachira WangechiK.D.H.RagatiNewPostnatal19.12.2007YHealth facilityRFYSince birthRFFormula since birthMother desserted child at birth. Sister now taking care of the baby. Baby died under mysterious circumstances

Active2 H22.01.2008Joseph Kamau WaruiK.D.H.KiamwangiNewPostnatal517Nov. 2007Septrin Prophylaxis05.12.2007YAZT, NVPHealth facilityBY3 weeks after birthBreast feeding3.3

Active3 H22.01.2008Dennis Mwai WachiraK.D.H.GathehuNewPostnatal21.11.2007YHealth facilityB1 week after birthBreast feeding

Active4 H22.01.2008Julius Maina GicheruK.D.H.KiangaiNewPostnatal195YAZT,NVPSeptrin Prophylaxis19.12.2007YAZT,NVPHealth facilityRFYSince birthRFFormula since birth2.9

Active5 H22.01.2008Rosebell Njeri WairimuK.D.H.Mukurwe-iniNewPostnatal

Active6 H22.01.2008Jacob Njoroge KinyuaK.D.H.KirinyagaNewPostnatal345YAZT,NVPApr-07Septrin Prophylaxis31.12.2007YAZT,NVPHealth facilityRFSince birthRFFormula since birth3.8Discordant couple

Active7 H07.02.2008Ally Wangui WanjikuK.D.H.SaganaNewPostnatal80023.11.2007YHealth facilityRFSince birthRFFormula since birth2.653.6Negative

Active8 H07.02.2008Allyson Wanjiru WanjikuK.D.H.SaganaNewPostnatal80123.11.2008YHealth facilityRFSince birthRFFormula since birth2.93.58Negative

Active9 H07.02.2008John Muthee NjorogeK.D.H.Gathu-iniNewPostnatal316AZT,NVP09.01.2008YAZT,NVPHealth facilityRFSince birthRFFormula since birth3

Active10 H07.02.2008Purity Wanjiku GachariK.D.H.KanjuriNewPostnatal154AZT,NVPSeptrin Prophylaxis11.01.2008YAZT,NVPHealth facilityRFSince birthRFFormula since birth2.8

Positive0

Negative2

No results8

Defaulters0

Relocated0



Results Perod: September 2005 to January 20083 Public Hospitals: Maragua (rural), Karatina (semi-urban), Nyeri (urban).

577 infants included in the replacement feeding program (RF)DNA-PCR results available in 402 infants- 214 (53.2%) infants completed 6 months of RF- 163 (40.5%) still active- 10 (2.4%) died- 15 (3.7%) Lost to follow up

Received breastmilk before inclusion in RF program: 44 (10.9%) infants, 9 (18%) HIV positive. Never exposed to breastmilk: 358 (89.1%), 11 (3.1%) HIV positive. OR (IC95): 7.88 (2.77-22.29) p

Period evaluated January-December 2007 for 344 HIV infected children included in the HAART program and for 142 pairs (mothers and infants) included in the comprehensive PMTCT program.

Costs included in the analysis: medications (ARV and opportunistic infections OI), replacement feeding up to 9 months, safe water kit, labour costs, laboratory and transport costs.

Costs not included: In patient department admissions, costs related to human resources, trainings and infrastructures such as the construction of a paediatric HIV clinic, psychosocial, home based care and costs related to disabilities.

Cost of 1 year treatment (HAART):150,2 USDCost of PMTCT+ package:576,5 USDFinancial costs of treating and preventing pediatric HIV infection during one year. The experience of Maragua, a rural district in Central Kenya

Findings from an assesment conducted in 2 District Hospitals with no RF during the scaling up process.

M. Manzi, R Zachariah, R Teck et al. High acceptability of voluntary counselling and HIV testing but unacceptable loss to follow up in a PMTCT program in rural Malawi: scaling up requires a different way of acting. Tropical Medicine and International Health. Vol 10, No 12, 1242-1250 Dec 2005. 3 infants were discharged after completing the national HIV testing algorithm (Kiambu).

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Postnatal visits of HIV exposed infants in PMTCT clinic. Thika (Apr-Dec 07) and Kiambu (2007).

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Postnatal care of HIV exposed infants in PMTCT clinic. Thika and Kiambu.

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LaboratoryCCC-HIV clinicPharmacyMCH- Antental and postnatal clinicsHigh Risk clinicPMTCT officeRegistration. ANC cardNutritionFlow of HIV positive pregnant women in the hospital

Safety and Efficacy of a Replacement Feeding Program for Prevention of Mother to Child Transmission (PMTCT) of HIV in a Resource Limited Rural Setting: The Experience of Maragua District, Central Province, Kenya4th IAS Conference. Sydney 2007. Abstract TUPEB107

Capsule SummaryCCO Official Conference Coverage of the 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention

Formula Feeding Helps Prevent MTCT and Considered Safe in Resource-Limited SettingsPosting Date: August 21, 2007

Summary of Key ConclusionsLow morbidity and mortality with replacement (formula) feeding

Low rate of mother-to-child transmission (MTCT) of HIV with combination of replacement feeding for infants and antiretroviral drugs

May provide a safe alternative to breastfeeding in preventing vertical transmission of HIV-1 infection

Hoosen Coovadia, MBBS, MDMauro Schechter, MD, PhDRichard E. Chaisson, MD

Lessons learnedIt is possible to effectively implement WHO recommendations and achieve good HIV free survival in the public sector. MoH overall coordinator and partners supporting MoH program.

HIV infected mothers should be supported in their choice: Ungent need to remove the Affordability of the AFASS criteria.

Integration of HIV care in MCH services reduces referrals of HIV infected pregnant women to other departments and improves quality of care

Postnatal care in 4 programs recommending breastfeeding with no support for HIV+ mothers opting not to breastfeed is almost non existant. Urgent need for MoH and partners to sit and understand why.

Exposure to breast milk is associated with high rates of HIV transmission and HIV infection is associated with high risk of mortality.

Weaning from RF is easier than from EBF. The risk of mixing RF with other feeds, (no BF) does not increase HIV infection (ERF is not an absolute must).

Lessons learned (ii)Small support groups (up to 20 mothers), M2M and distribution of milk in a community set up increases partner involvement. PMTCT and PMTFT when discordant couples are found (positive prevention). Infant formula will always have to be there. 7-10% of infants could not breastfeed due to multiple pregancies, not enough milk (low CD4 and advanced infection) and mothers death or abandonment.

Programs already providing pediatric HAART should also have replacement feeding as an option for mothers opting not to breastfeed

Availability of RF accelerates acceptance and disclosure of HIV infection. Case holding is very high in postnatal clinics compared to mothers breastfeeding because no support is given to them.

Supporting HIV infected mothers who choose not to breastfeed their infants is safe and highly effective in preventing pediatric infections in areas with limited resources. Many of them are already giving animal milk due to lack of support. The potential role of the HIV infected mothers remain understimated as access to RF is less than 1% in SSA today (excluding South Africa and Botswana).

Challenges

Feeding bottle versus cup. Majority of mothers prefer the bottle despite being counselled on the cup. Is it possible to implement such a policy?*

RF programs have been threatened because of fear of spill over to HIV negative mothers. Exclusive breastfeeding campaign needs a different approach with more political commitment (e.g. realistic maternity leave).

*Cup-Feeding Not Recommended Over Bottle-Feeding as a Supplement to Breast-Feeding Cochrane Database Syst Rev. Published online April 18, 2007.

Challenges (ii)We found no studies taken to improve safety in RF in areas with limited resources although it is the common practise in developed world. Are we still in the aftermath of the 70s when infant formula was irresponsibly marketed (era pre HIV epidemic)?

International code of marketing breast-milk substitutes (1981). No infant formula in MCH clinics (negative impact: e.g.Maragua experience with IF distributed in CCC).

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Challenges (iii)Urgent need of a low cost, high quality, generic infant formula with local production and duty free.

General fear to take a risk and try to do in Africa what has proved effective in the developed world rather than suboptimal recommendations than keep us discussing for long and not solving the problem.

MSF-CAME big role to play...

Infant feeding and MSFMajor challenges/obstacles in having safe replacement feeding available: 1The quality of water. MSF has a Wat/San unit.2Advocacy for best practises also in SSA. Generic infant formula. CAME?

Thank you for your attention

Documents

A HIV free new generation in Central Province, Kenya. VIhDA Association Victorio Torres Feced June 24th 2008 Access Campaign – Experts roundtable Hotel