Background:  Since Early Infant Diagnosis (EID) via dried blood spot (DBS) was launched nationally in 2006, coverage has increased dramatically. Multipronged infant identification strategies including HCW training, documentation of exposure status on health cards, routine testing and counseling for hospitalized children, strengthened referrals and integration of EID into EPI outreach have been utilized. However to date, no national level review of EID program processes or outcomes has been conducted.

Methods:  A retrospective review was completed in 20 EID collection sites randomly selected spanning 4 regions and 5 types of health centers. Site level program data gathered with a standardized questionnaire was compiled with central laboratory and key informant interviews with national counterparts. The data collection took place in Nov to Dec 2009, and analysis begun in mid-December.

Results:  In 3 years, annual EID sample volumes rose from ~100 in 2006 to over 30,000 in 2009, with a 10-fold increase in monthly volumes. EID collection sites have increased from 7 (end Q4 06) to 536 (end Q3 09) across 91 districts. Though EID began at tertiary centers, national efforts decentralized EID throughout the health system; Health Center II’s and III’s currently comprise 48% of the total collection sites however service utilization shows these sites account for only 16% of EID samples collected in 2009. Significant efforts in training have reduced the average age at testing across all sites from 7.4 months in Jan 2008 to 6.1 months in Nov 2009, with no dramatically different trends by health structure type (Referral Hospitals: 6.4 m to 5.3 m; HC IVs 7.5 m to 7.0 m). The positivity rate however has decreased over time from 29.4% in Q4 06 (n = 109) to 9.9% in Q3 09 (n = 7535). Despite adequate turn around times for EID of <30 days, preliminary analysis shows significant attrition rates post testing, (~43% of infants EID tested never receiving their results at 3 Referral Hospitals) and continued attrition of HIV⁺ infants prior to enrolling in ART services.

Conclusions:  Strategic, ambitious planning and strong national leadership have resulted in a rapid scale up of EID with more children being tested at earlier ages. However challenges remain with return of test results and follow up. A strengthening approach reinforcing exposed infant care via boosted cotrimoxazole, counseling, early testing, and follow-up is needed and is being rolled out to ensure maximum impact of EID.