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We conducted an observational study in Malawi to understand the patient impact of implementing point-of-care early infant diagnosis (POC EID). Antiretroviral treatment initiation rates were significantly improved with the implementation of same-day POC EID testing compared with referred, longer-turnaround laboratory-based testing.

Abstractobjective To assess follow-up and programmatic outcomes of HIV-exposed infants at Martin Preuss Centre, Lilongwe, from 2012 to 2014.methods Retrospective cohort study using routinely collected HIV-exposed infant data. Data were analysed using frequencies and percentages in Stata v.13.results Of 1035 HIV-exposed infants registered 2012-2014, 79% were available to be tested for HIV and 76% were HIV-tested either with DNA-PCR or rapid HIV test serology by 24 months of age. Sixty-five infants were found to be HIV-positive and 43% were started on antiretroviral therapy (ART) at different ages from 6 weeks to 24 months. Overall, 48% of HIV-exposed infants were declared lost-to-follow-up in the database. Of these, 69% were listed for tracing; of these, 78% were confirmed as lost-to-follow-up through patient charts; of these, 51% were traced; and of these, 62% were truly not in care, the remainder being wrongly classified. Commonest reasons for being truly not in care were mother/guardian unavailability to bring infants to Martin Preuss Centre, forgetting clinic appointments and transport expenses. Of these 86 patients, 36% were successfully brought back to care and 64% remained lost-to-follow-up.

Background Perinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi. Methods We screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted qualitative interviews with 24 women experiencing PND and analyzed data using inductive and deductive coding and narrative analysis. Results Women experienced a double burden of physical and mental illness, expressed as pain in one's heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key contributor to developing PND. This development was influenced by stigmatization and social support. Conclusions These findings highlight the need to recognize the mental health implications of routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally appropriate mental health interventions are needed in settings with a high HIV burden.

20 21 Background: Perinatal depression (PND) can interfere with HIV care engagement and outcomes. 22 We examined experiences of PND among women living with HIV (WLWH) in Malawi. 23 24 Methods: We screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the 25 Edinburgh Postnatal Depression Scale (EPDS). We conducted interviews with 24 women 26 experiencing PND and analyzed data using inductive and deductive coding and narrative 27 analysis. 28 29 Results: Women experienced a double burden of physical and mental illness, expressed as pain 30 in one's heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key 31 contributor to developing PND. This development was influenced by stigmatization and social 32 support. 33 34 Conclusions: These findings highlight the need to recognize the mental health implications of 35 routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally 36 appropriate mental health interventions are needed in settings with a high HIV burden. 37 38 Introduction 39The scale-up of antiretroviral therapy to all pregnant and breastfeeding women living 40 with HIV, known as Option B+, has the potential to dramatically improve maternal health and 41 end mother-to-child HIV transmission (MTCT) (1). In Malawi, all pregnant women diagnosed 42 with HIV in antenatal care (ANC) begin lifelong antiretroviral therapy (ART) under Option B+ 43 (2). However, women who initiate ART during pregnancy under Option B+ are one-fifth as 44 likely to return to HIV care after their initial visit compared to non-pregnant women initiating 45 ART in Malawi (3). Maternal mental health is likely an important factor in undermining the 46 delivery of Option B+ by affecting initiation of and retention in HIV care, with implications for 47 ongoing risk of MTCT and negative effects on women's quality of life and psychological well-48 being (4). 49Globally, adults living with HIV are at an increased risk of depression, with the 50 association being stronger among patients who are newly diagnosed and women (5). A 51 systematic review conducted in high-, middle-, and low-income countries found that pregnant 52 and postpartum women living with HIV are at particularly high risk for perinatal depression 53 (PND) due to multiple bio-psychosocial risk factors (4). These risk factors include increased 54 stress, HIV-related stigma, a lack of social support, concerns about disclosing their HIV status, 55 and concerns about their infant's health and HIV status (4). 56Through Option B+, more women are becoming aware of their HIV status and initiating 57 ART during the perinatal period. Simultaneously, many are experiencing PND. PND is known to 58 affect 13.1% of women in low and middle-income countries, with as many as 19.2% of women 59 having a depressive episode within the first three months postpartum (6,7). Among women living 60 with HIV in Sub-Saharan Africa, a meta-analysis found a pooled prevalence for PND of 42.5% 61 for prenatal women and 30.7% for postpartum women, indic...