{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:01:54Z","timestamp":1791997314606,"version":"4.4.0"},"reference-count":58,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Joint Malawi-Liverpool Wellcome-Trust Clinical Research Programme and College of Medicine.","award":["pre-PhD internship grant"],"award-info":[{"award-number":["pre-PhD internship grant"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health\ufffdServ\ufffdInsights"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>HIV testing among HIV-exposed infants (HEI) in Malawi is below global targets and, affected by low utilisation of health services after birth. We conducted a mixed methods evaluation of the implementation of services for early infant diagnosis (EID) of HIV against national guidelines in Blantyre, Malawi, to inform the development of strategies to improve EID services uptake. We estimated coverage of HEI enrolment in HIV care and HIV testing at 6\u2009weeks through a retrospective data review. We qualitatively explored implementation gaps in EID services through process mapping of 8 mother-infant pairs (MIP); and investigated healthcare workers\u2019 (HCW) perspectives on the implementation gaps through group interviews with 16 HCWs. We analysed the quantitative data descriptively and conducted a thematic content analysis of qualitative data. Of 163 HEIs born at the study sites, 39 (24%) were enrolled in an HIV care clinic before post-natal discharge, and 85 (52%) received HIV testing by 6\u2009weeks. The median time for MIP to receive EID services was 4 (1-8)\u2009hours. The implementation gaps observed during process mapping included: failure to identify and enrol HEI in HIV care clinic; lack of immunisation, counselling for HEI testing, HIV testing, drug refilling, and family planning; and different appointment dates for mother and infant. HCWs reported delays and gaps influencing optimal service provision including: lack of screening to identify MIP, limited supervision for student HCWs when providing services, inadequate capacity of point of care machines, challenges with integrating services, and role confusion. Use of unique identifiers for MIP and establishing a booking system to schedule appointments to suit point of care machine capacity were primary service improvement recommendations. This study identified suboptimal EID services in Malawi due to process, capacity, and system factors. Context-appropriate interventions accommodating systems thinking are needed to enhance service provision.<\/jats:p>","DOI":"10.1177\/11786329231224623","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T02:18:55Z","timestamp":1707099535000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Process Evaluation of Services for HIV-Infected Post-Partum Women and HIV-Exposed Infants in Primary Health Care Blantyre Malawi"],"prefix":"10.1177","volume":"17","author":[{"given":"Leticia Chimwemwe","family":"Suwedi-Kapesa","sequence":"first","affiliation":[{"name":"Liverpool School of Tropical Medicine, Liverpool, England, UK"},{"name":"Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alinane Linda","family":"Nyondo-Mipando","sequence":"additional","affiliation":[{"name":"Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi"},{"name":"Department of Health Systems and Policy, School of Global and Public Health Kamuzu University of Health Sciences, Blantyre, Malawi"},{"name":"Department of Women\u2019s and Children\u2019s Health, University of Liverpool, Liverpool, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustine","family":"Choko","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, Liverpool, England, UK"},{"name":"Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Obasi","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, Liverpool, England, UK"},{"name":"Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"MacPherson","sequence":"additional","affiliation":[{"name":"School of Health & Wellbeing, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Desmond","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, Liverpool, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,2,4]]},"reference":[{"key":"bibr1-11786329231224623","unstructured":"Joint United Nations Programme on HIV\/AIDS. UNAIDS-data. 2022. Accessed January 2023. https:\/\/www.unaids.org\/en\/resources\/documents\/2023\/2022_unaids_data"},{"key":"bibr2-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3217-3"},{"key":"bibr3-11786329231224623","unstructured":"Joint United Nations Programme on HIV\/AIDS. UNAIDS-data Global and regional HIV data. 2021:1-468. Accessed January 2022 https:\/\/www.unaids.org"},{"key":"bibr4-11786329231224623","unstructured":"World Health Organization. Implementation of Option B+ for prevention of mother-to-child transmission of HIV: the Malawi experience. 2014. Accessed October 2023. https:\/\/www.afro.who.int\/sites\/default\/files\/2017-07\/implementation-of-option-b%2B-for-prevention-of-mother-to-child-transmission.pdf"},{"key":"bibr5-11786329231224623","unstructured":"World Health Organisation. Consolidating Guidelines on The Use of Antiretroviral Drugs for Treating and Preventing HIV infection Recommendatioons for a Public Health Approch Vol. 2nd ed. HIV\/AIDS Do; 2016:1-480. Accessed January 2022. https:\/\/www.who.int\/publications\/i\/item\/9789241549684"},{"key":"bibr6-11786329231224623","unstructured":"World Health Organisation. WHO Recommendations on the Diagnosis of HIV infection in Infants and Children 2010:2-64. Strengthening health services to fight HIV\/AIDS. Accessed January 2022. https:\/\/www.who.int\/publications\/i\/item\/9789241599085"},{"key":"bibr7-11786329231224623","unstructured":"World Health Organization. Guidelines: updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring. 2021. 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Malawi Poupulation-Based HIV Impact Assessment MPHIA 2015-2016. Final Report. AIDS Ha; 2018:2-308. October 2018. Accessed January 2022. https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2020\/02\/MPHIA-SS_2018_FINAL.pdf"},{"key":"bibr29-11786329231224623","unstructured":"Joint United Nations Programme on HIV\/AIDS. UNAIDS-data Global and Regional monitoring data. Accessed February 2019. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2019-UNAIDS-data_en.pdf"},{"key":"bibr30-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.13209"},{"key":"bibr31-11786329231224623","unstructured":"Malawi Guidelines for Clinical Management of HIV in children and adults (Universal Copyright Convection) 1-128 (2018)."},{"key":"bibr32-11786329231224623","unstructured":"Ministry of Health and Population Malawi. Standard operating procedures for early infant diagnosis of HIV. 2017. 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Accessed February 2023. http:\/\/www.nsomalawi.mw\/images\/stories\/data_on_line\/general\/yearbook\/2022_Malawi_Statistical_Yearbook.pdf"},{"key":"bibr36-11786329231224623","volume-title":"Health Sector Strategic Plan II 2017-2022 Towards Universal Health Coverage","author":"Government of the Republic of Malawi","year":"2017"},{"key":"bibr37-11786329231224623","unstructured":"Government of the Republic of Malawi Ministry of Health. National Community Health Strategy 2017-2022. Ministry of Health Lilongwe; 2017."},{"key":"bibr38-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-002220"},{"key":"bibr39-11786329231224623","first-page":"937","author":"Madathil S","year":"2020","journal-title":"Inst Ind Syst Eng"},{"key":"bibr40-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c4078"},{"key":"bibr41-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15479"},{"key":"bibr42-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1177\/2374373518783763"},{"key":"bibr43-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1177\/16094069231153610"},{"key":"bibr44-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"bibr45-11786329231224623","doi-asserted-by":"publisher","DOI":"10.1177\/1609406917733847"},{"key":"bibr46-11786329231224623","unstructured":"Ministry of Health and Population Malawi. Clinical mamagement of HIV in Children and Adults. 2022. 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