Early Infant Diagnosis (EID) aims to test infants for HIV soon after birth – a crucial approach to reducing HIV-related morbidity and mortality in children.

In the African country of Angola, EID is a challenge. Testing by two months of age for infants perinatally exposed to HIV remains low.

Supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), ICAP at Columbia University has significantly improved Angola’s capacity to provide EID testing across 22 health facilities over the course of five years.

In 2019, ICAP in Angola began providing direct technical assistance to health facilities in Benguela, Huambo, Cunene, and Lunda Sul provinces to improve EID testing for infants exposed to HIV. To increase timely sample collection, return of results, and prompt initiation of antiretroviral treatment for infants diagnosed with HIV, ICAP conducted training and mentorship of health providers and regular review of clinical files to determine infants exposed to HIV who were due for EID testing.

After one year of training and support, EID testing increased significantly. For example, a total of 1,333 HIV-exposed children were seen during clinical visits in 18 health facilities during the period between October and December 2021. Of these children, 554 were identified as eligible for EID testing – 601 HIV-exposed children had a sample collected for EID in that quarter.

“EID testing is critical for early initiation of antiretroviral therapy for children living with HIV, and ultimately, for a suppressed viral load,” said Lucille Bonaventure, MA, country director for ICAP in Angola. “Ensuring that health facilities have the necessary equipment, tools, and trained personnel to conduct EID – and affirm to families affected by HIV its importance – is the essential first step of achieving that goal.”

In 2024, in collaboration with CDC, ICAP established a Collaborative Quality Improvement program for EID. As a part of this program, CDC Angola conducted an Internal Quality Improvement methodology training session for ICAP clinical officers. ICAP then conducted a Quality Improvement workshop for 22 PEPFAR-supported health facilities, further building the capacity of health providers to use, analyze, and deliver quality HIV data for improved patient outcomes.

The proportion of infants among whom an EID sample was collected by two months of age was 45 percent before this training; following the training, EID coverage reached 85 percent. There were, however, significant differences in EID coverage by province, with Cunene at 75 percent, Lunda Sul at 78 percent, Benguela at 91 percent, and Huambo at 88 percent, indicating a further need to address gaps.

In March 2024, to achieve EID coverage of more than 95 percent, ICAP fostered an important collaboration with Reaching Impact, Saturation, and Epidemic Control (RISE), another ICAP-supported program in Angola. The collaborative teams worked together to improve EID coverage of infants at two months of age through Community Dried-blood Spot (DBS) sample collection. DBS collection, which requires a small amount of blood taken from the fingertip or heel, was piloted to complement facility-based sample collection and increase coverage in rural and hard-to reach communities in Huambo.

The National Institute for the Fight Against AIDS (INLS), RISE, CDC, and lab partner AFNET provided training to 23 community counselors on DBS collection in Huambo province. Before the pilot, the median time from birth to collection of the first EID sample from an infant was 62 days, which decreased to 35 days post-intervention. EID coverage of infants at two months increased to 94 percent in Huambo province. Based on these results, INLS is scaling up the pilot to two additional provinces.

“The quality improvement collaborative fostered an environment for health care workers from various facilities to learn and share best practices,” said Luisa Chauca, RISE chief of party. “The synergy between these projects enabled counselors to offer early infant diagnosis services, health education, and psychosocial support to mother-infant pairs at home. This holistic approach leverages the strengths of both projects to deliver quality services to pregnant and breastfeeding women and their infants.”

HIV progresses more quickly in infants, which is why EID testing is so crucial. Over the course of its five-year program, ICAP in Angola more than doubled EID testing coverage in participating facilities – a transformational step toward ensuring early identification of HIV and maximizing the health and well-being of children across the country.

About ICAP

A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu