Setting: Mzuzu Central Hospital (MZCH), Mzuzu, and
Chitipa District Hospital (CDH), Chitipa, Malawi.
Objective: To compare management and outcomes of
human immunodeficiency virus (HIV) exposed infants in
early infant diagnosis (EID) programmes at MZCH, where
DNA polymerase chain reaction (PCR) testing is performed
on site, and CDH, where samples are sent to
MZCH, between 2013 and 2014.
Design: Retrospective cohort study.
Results: Of infants enrolled at MZCH (n = 409) and
CDH (n = 176), DNA PCR results were communicated
to the children’s guardians in respectively 56% and
51% of cases. The median time from sample collection
to guardians receiving results was 34 days for
MZCH and 56 days for CDH. In both hospitals, only
half of the dried blood spot (DBS) samples were collected
between 6 and 8 weeks. More guardians from
MZCH than CDH received test results within 1 month
of sample collection (25% vs. 10%). Among the
HIV-positive infants, a higher proportion at MZCH
(92%) started antiretroviral therapy than at CDH
(46%). The relative risk (RR) of death was higher
among infants with late DBS collection (RR 1.3, 95%CI
1.0–1.7) or no collection (RR 5.8, 95%CI 4.6–7.2),
and when guardians did not receive test results (RR
8.3, 95%CI 5.7–11.9).
Conclusion: EID programmes performed equally poorly
at both hospitals, and might be helped by point-of-care
DNA PCR testing. Better programme implementation
and active follow-up might improve infant outcome and
retention in care.