Longitudinal Implementation of a Neurodevelopmental Screening Program for Children Born to Mothers Living With HIV in Maternal-Child Clinics in Kenya: A Mixed Methods Study

Abstract

BackgroundChildren with perinatal HIV exposure are at increased risk for neurodevelopmental (ND) delays, yet little is known about ND screening implementation for this population.MethodsThis longitudinal study evaluated ND screening implementation at a health clinic in Kenya, from 9/2021 to 8/2023. Children aged 18-36 months with perinatal HIV exposure were screened using a 12-item general ND tool. Implementation outcomes-acceptability, feasibility, fidelity, and sustainability-were assessed through time-motion observations, clinic records, and semi-structured interviews with caregivers and staff.ResultsOf 507 eligible children, 405 (80%) were screened. Screening rates were consistent over 24 months, with average time reduced to under 5 min. Facilitators included staff collaboration and caregiver support; barriers included time constraints and child temperament.ConclusionsND screening was acceptable, feasible, and sustainable. Policymakers should embed ND screening within national child health programs, invest in workforce training and task-sharing models, strengthen referral and follow-up systems, and ensure affordable access to services.