| Issue/Objective |
Missed follow-up in early infant diagnosis (EID) remains a primary barrier to eliminating mother to child transmission of HIV, particularly in high-burden settings like Southern Africa. In Eswatini, fragmented community facility linkages have historically limited EID completion. In response, Young Heroes organisation supports the government of Eswatini in implementing a real time, integrated tracking system to synchronize community and facility data and close last mile gaps in the EID cascade.
Objective: To evaluate the population level impact of a real time community to facility case tracking system on EID cascade completion among HIV-exposed infants (HEIs) aged 0-24 months.
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| Methodology/Approach |
We conducted a programmatic cohort analysis amongst HEIs enrolled in Young Heroes between October 2025 and March 2026 via facility referral and active community case finding. A real time, weekly line list platform linked community health workers and facility teams to track and act on EID milestones (birth, 6-8 weeks, 9, 12, and 18-24 months). Outcomes included tracking completeness, HIV status documentation, and missed follow-up. Pre and post comparisons (November baseline vs. March endline), relative risks (RR), incidence rate ratios (IRR) and time-trend analyses were applied. |
| Results |
Among 1,787 HEIs enrolled, HIV status was documented for 1,583 (88.6%). Interval tracking increased from 70% in November to 85% by March, with a sustained upward trend per month (p=0.02, +3.8 percent points per month). By endline, documentation exceeded 90% across all testing intervals and reached 100% at birth. Missed follow-up declined by 60% (IRR=0.40), effectively closing a major gap in the EID cascade. Three HIV positive infants (0.06%) were identified and immediately initiated on antiretroviral therapy. |
| Discussion/Conclusion |
A real time, integrated community to facility tracking system rapidly reducing missed follow-up as a major barrier in the EID cascade, achieving near universal coverage within six months of implementation. These findings demonstrate that synchronizing community and facility data can deliver immediate impact and represent a scalable and policy ready solution to accelerate elimination of mother to child HIV transmission in high-burden settings like Eswatini. |
| Presenters and Affiliations |
Themba matsebula Matsebula Young Heroes Organisation |
