J Acquir Immune Defic Syndr

ObjectiveEarly infant diagnosis (EID) is the first step in HIV care, yet 75% of HIV-exposed infants born at two hospitals in Mozambique failed to access EID.DesignBefore/after study.SettingTwo district hospitals in rural Mozambique.ParticipantsHIV-infected mother/HIV-exposed infant pairs (N=791).InterventionWe planned two phases of improvement using quality improvement methods. In Phase 1, we enhanced referral by offering direct accompaniment of new mothers to the EID suite, increasing privacy, and opening a medical record for infants prior to post-partum discharge. In Phase 2, we added enhanced referral activity as an item on the maternity register to standardize the process of referral.Main outcome measure(s)The proportion of HIV-infected mothers who accessed EID for their infant <90 days of life.ResultsWe tracked mother/infant pairs from June 2009 to March 2011 (Phase 0: N=144; Phase 1: N=479; Phase 2: N=168), compared study measures for mother/infant pairs across intervention phases with chi-square, estimated time-to-EID by Kaplan-Meier, and determined the likelihood of EID by Cox regression after adjusting for likely barriers to follow-up. At baseline (phase 0), 25.7% of infants accessed EID