Meet the CIPHER grantees
||University of North Carolina Project (UNC Project-Malawi)
||Mina Hosseinipour, University of North Carolina-Chapel Hill
Maganizo Chagomerana is an epidemiologist and Director of the Analysis and Manuscript unit at the University of North Carolina Project-Malawi
More information on Maganizo Chagomerana | Email
“The complexity and long processing period of dried blood spot samples for early infant diagnosis result in damaged samples, delays in ART initiation, and loss to follow up. This CIPHER project will implement and evaluate a novel differentiated service delivery strategy that identifies, reaches and engages high-risk mother-infant pairs and offers them point-of-care early infant diagnosis in the community to enhance back-to-care activities and reduce delays in treatment initiation for infants living with HIV.”
Research project: Feasibility pilot to characterize a differentiated service delivery model for HIV early infant diagnosis in high-risk mother-infant pairs
Early diagnosis of infants living with HIV is vital to ensure their timely access to life-saving antiretroviral therapy (ART) and reduce infant morbidity and mortality. Because of HIV diagnostic delays, many infants living with HIV do not start ART before the period of peak mortality at two or three months of age. New and impactful service delivery strategies are needed to ensure that mother-infant pairs (MIPs) remain in care so that HIV-exposed infants are regularly tested for HIV, and if positive, started on ART.
The CIPHER project
Led by Dr Chagomerana, this study will enrol 300 high-risk MIPs from two peri-urban health centres in Lilongwe, Malawi. The study will:
- Evaluate the feasibility and early effectiveness of the point-of-care early infant diagnosis (POC EID) community model in reaching and bringing high-risk MIPs back to care and testing their infants in the community
- Describe barriers and facilitators of integrating the POC EID community model in the national prevention of mother-to-child transmission/EID programme
- Understand maternal demographic, clinical and behavioural factors associated with having an undiagnosed positive infant.
To evaluate these aims, Dr Chagomerana will conduct a quasi-experimental pilot study of high-risk MIPs receiving under-five clinic services. Two purposely selected peri-urban health centres with high-volume maternity and under-five clinic services will be assigned to either the standard-of-care arm (standard tracing of high-risk MIPs without community POC EID testing) or the intervention arm (active tracing of high-risk MIPs and community POC EID testing).
The study will help inform policy about a potential new differentiated service delivery model that is family focused and will ensure universal access to HIV testing and diagnosis for infants. The proposed strategy holds promise to narrow the gaps in HIV testing, ART uptake and loss to care among HIV-exposed infants in Malawi and move the country closer toward achieving the UNAIDS 95:95:95 targets.