Improving Early Infant Diagnosis in Five Health Facilities in

Benue State: A Quality Improvement Project

Omuh, Helen. M.B.B.S., MS1. Milaham, Makplang M.B.B.S, MHM2; Aimu, Rifkatu RN/RM/BSc Nurs1; Achikeh, Cyrina
RN/RM3; Nwagwu, Rebecca RN/RM3; Nwebonyi, David BSc3; Uji, Akor BSc4; Okwuosah, Anthony. M.B.B.Ch, FWACP1
Ekong, Ernest. MD, PhD1,5.
1Prevention Care and Treatment, Institute of Human Virology Nigeria, Abuja, 2Prevention Care and Treatment, Institute of Human Virology Nigeria, Katsina State, 3Prevention Care and Treatment,
Institute of Human Virology Nigeria, Nasarawa State, 4Prevention Care and Treatment, Institute of Human Virology Nigeria, Benue State, 5Institute of Human Virology, University of Maryland School of
Medicine, Baltimore, USA.

Table 1: Improving Early Infant Diagnosis Project Report

DBS SAMPLE COLLECTION FMC BSUTH USHONG WAAPE OSTRA
MAKU O CHC RA CHC GUM
Early infant diagnosis (EID) of HIV provides a critical opportunity RDI
to strengthen follow-up of HIV exposed infants (HEI) and assure
BASELINE
early access to antiretroviral (ARV) treatment for infected children
Pre-intervention percentage of HEI 65 30 30 0 30
to minimize morbidity and mortality (1–4) . However, only 29.6% who had DBS by 6 – 8 weeks          
of infants born to HIV positive women had test done at less than OUTCOME INDICATOR
eight weeks of age(5). The objective was to increase the proportion Percentage of 63 76 92 93 100
of EID at 6-8 weeks of age to at least 70% between January - June HEI who are 6-8 weeks of age and
2017 had their DBS sample collected
every month
Numerator: No. of HEI who are 6-8 64 13 11 13 10
B. Methods weeks of age and had their DBS
sample collected every month
Denominator: No. of HEI who are 6- 101 17 12 14 10
Federal medical center Makurdi, Benue State university teaching 8 weeks of age every month (as
hospital (BSUTH), Comprehensive health Centres (CHCs) Ostra documented in the child follow up
Gum, Ushongo and Waapera were selected based on low rates of register)
EID within this age. The interventions included establishing birth
PROCESS INDICATORS
notification system between the delivery and child follow up (CFU)
TRACKING
unit, documentation of all deliveries within 24-48 hours in the
Numerator: No of HEIs who missed 32 15 10 2 11
registers; and provision of standardized tracking registers to mentor
appointment for DBS sample
mothers (MM).
collection within the week and
Process indicators were the number of HEIs delivered in the facility were tracked by MM and returned
referred to the designated focal person and properly documented to care
weekly and tracking by MM of HEIs who missed appointment for
sample collection. Outcome indicator was the percentage of 6-8 Denominator: No of HEIs who 38 15 11 2 11
weeks HEIs who had their DBS sample collected missed appointment for DBS
sample collection within the week
DOCUMENTATION
Numerator: No of HEIs delivered in 88 15 8 12 3
C. Results the facility referred to the
designated focal person and
properly documented into the CFU
Significant improvement observed in all facilities except in FMC
register every week
Makurdi (See Table 1 and Charts 1 – 3).
Denominator: No of HEIs delivered 93 15 8 12 3
Chart 1: Percentage of HEI who are 6-8 weeks of age and had their DBS sample in the facility (from the PMTCT
collected every month in Federal Medical Center Makurdi delivery register)

Challenges identified were paucity of trained staff capable of collecting DBS,

stock out of DBS Kits and PCR reagents and unsynchronized PNC days and DBS
collection days
DBS Kit Stock Out

Chart 2: Percentage of HEI who are 6-8 weeks of age and had their DBS sample
collected every month in Benue State University Teaching Hospital Makurdi
Chart 3: Percentage of HEI who are 6-8 weeks of age and had their DBS sample
collected every month in Comprehensive Health Centers Ushongo, Waapera Tertiary Hospital in Nigeria, 2010-2014. Int J MCH AIDS [Internet]. 2015;3(2):168–73. Available from:
and Ostra Gum.
D. Conclusions
Findings show that EID can be optimized for timely diagnosis of vertical
transmission, linkage to treatment and reduction in morbidity and mortality
of these infants if identified challenges are addressed
Keys Words: HIV, Early Infant Diagnosis, Quality
Reference
1. Khamofu H, Oladele E, Ralph-Opara U, Badru T, Adedokun O, Saleh M, et al. Decline in positivity rates among HIV-exposed
No HEI
infants with changes in prevention of mother-to-child transmission antiretroviral regimens in Nigeria: Evidence from 7 years of field
implementation. J HIV Hum Reprod [Internet]. 2015;3(2):34–40. Available from: http://www.j-hhr.org/text.asp?
2015/3/2/34/186351
2. Oluwayemi IO, Olatunya SO, Ogundare EO. PCR Results and PMTCT Treatment Outcomes among HIV-Exposed Infants in a
http://www.ncbi.nlm.nih.gov/pubmed/27621996%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5005991
3. Sagay AS, Ebonyi AO, Meloni ST, Musa J, Oguche S, Ekwempu CC, et al. Mother-to-child transmission outcomes of HIV-
exposed infants followed up in jos north-central nigeria. Curr HIV Res [Internet]. 2015;13(3):193–200. Available from:
http://benthamscience.com/contents-JCode-CHR-Vol-00000009-Iss-00000008.htm http://ovidsp.ovid.com/ovidweb.cgi?
T=JS&PAGE=reference&D=emed13&NEWS=N&AN=2015066267
4. Ugochukwu EF, Kanu SO. Early infant diagnosis of HIV infection in southeastern Nigeria: prevalence of HIV infection among
HIV-exposed babies. West Afr J Med [Internet]. 2010;29(1):3–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20496330
5. NACA. FACT SHEET: Prevention of Mother to Child Transmission (PMTCT), 2016 - NACA Nigeria [Internet]. 2016 [cited 2018
Jul 11]. Available from: https://naca.gov.ng/fact-sheet-prevention-mother-child-transmission-pmtct-2016/