Pediatric HIV: Use of case-based surveillance system to conduct HIV exposed infants’ positivity audits in 123 facilities within Kajiado and Nairobi counties, Kenya

Abstract

Background: Recognizing the necessity for targeted interventions to mitigate mother-to-childbtransmission (MTCT) of HIV, we've bimplemented a case-based surveillance (CBS) system aimedbto improve audits for HIV-exposed Infants (HEI) in Kajiado and Nairobi. Challenges with paperbased audit systems included data standardization, quality, completeness, and missedbopportunities for audits.

Methods: Utilizing open data kits (ODK), data collection commenced in April 2023 and continuedbthereafter, with analysis conducted bweekly by project data scientists. Visualization is facilitatedbthrough a custom CBS system, enabling the identification of transmission bgaps and informingbtargeted interventions to reduce vertical HIV transmission.

Results: Significant progress was noted, the proportion of positive cases audited increased from 41% in March 2023 to 97% by September  2023. Key findings included late gestation at first ANC visit, modest self-reported adherence rates, and low rates of HIV status  disclosure. Median infant age at enrollment into care and at first HIV diagnosis was 9 months, with a notable proportion reported as  being mixed-fed under 6 months.

Conclusions: The integration of CBS and ODK enhanced data quality, completeness, and reporting  consistency, with implications for improved healthcare delivery across all age groups. The evolving system should prioritize innovative  solutions to optimize maternal and child health outcomes.