Monkey Bay

Researchers are evaluating a new community-based approach called the PAC-Man model to improve early infant diagnosis (EID) testing and maternal viral load testing among pregnant and breastfeeding women living with HIV in Malawi. This study uses a hybrid effectiveness-implementation stepped-wedge trial design to compare the PAC-Man model against the standard care provided by the Ministry of Health. The PAC-Man model aims to reduce mother-to-child transmission of HIV by integrating proven practices into community settings, focusing on high-risk mother-infant pairs. The PAC-Man model includes three key practices: pediatric active case finding using novel point-of-care EID technology, same-day antiretroviral therapy initiation for infants diagnosed with HIV, and maternal viral load testing with follow-up care. This model uses mobile care teams equipped with new diagnostic tools that deliver services directly in the community. The study involves gradually rolling out the PAC-Man model across 12 sites grouped into four clusters, comparing outcomes during the transition from standard care to the new model. Participants include mother-infant pairs enrolled in the national EMTCT program, with additional groups involved for interviews and focus groups. Researchers will track the proportion of infants receiving timely EID testing by age six months and assess maternal viral load testing adherence. Data collection includes surveys, interviews, and focus group discussions with health providers and policy makers. The study monitors implementation success and health outcomes over time to determine the model's impact on preventing mother-to-child HIV transmission.