P2B211: Wezesha Watoto: Implementation of Clinic-based Developmental Screening in Kenya

Background: Children with perinatal HIV exposure have higher rates of neurodevelopmental delays (NDD) compared to those without perinatal HIV exposure. Little is known about the implementation of screening programs for NDD in clinical settings, especially where rates of perinatal HIV exposure are highest. This study aimed to evaluate the acceptability, feasibility, fidelity, and sustainability of integrating a developmental screening tool in a maternal and child health (MCH) clinic in Kenya.

Methods: This mixed-methods implementation study takes place within infrastructure of Academic Model Providing Access to Healthcare (AMPATH) in Eldoret, Kenya. Developmental screening was integrated within a public MCH clinic in September 2021 and is ongoing for children ages 18-36 months with perinatal HIV exposure. The tool was locally developed and consists of 12 items screening areas of cognition, language, motor, and social development. Feasibility, sustainability, and fidelity were measured with weekly time-motion analysis of clinic flow and clinic record review. Acceptability, feasibility, and sustainability were evaluated using a decision tree cost analysis based on the Kenyan gross domestic product and semi-structured interviews of caregivers and clinic staff, completed at baseline, 6 months, and 12 months post-implementation. Cost analysis included assumptions that early screening would lead introduction of therapy in at least 75% of those found to have NDDs and that would reduce loss of economic potential due to NDD by 50%. Data was analyzed using descriptive statistics, TreeAge Pro, thematic coding, and triangulation.

Results: Since onset, 229 children were screened (71.8% of eligible), with screening rate consistent over time. Average time to complete screening decreased over time (range=4-7 minutes, mode=4 mins). Perceived time of screening was inflated (16-20 mins). Facilitators to screening included staff teamwork and caregiver cooperation, with barriers including lack of time and child’s mood. Caregivers appreciated staff's concern for their child’s development and noted ease in answering questions. Staff’s remarks were congruent, while emphasizing the need for motivating incentives for children and staff. At 6 months, staff noted screening had become routine. They desired feedback on performance and provided ideas for improvement. Caregivers frequently asked about availability of assistance if potential delays are identified during screening. At 12 months, staff desired further training on neurodevelopment and identified it as a necessity for sustainability of screening efforts. They view expansion of screening to all children at MCH positively and emphasized that knowledge of good development is important to caregivers. Cost analyses found this developmental screening cost approximately $3.50 per screening. Screening in early life would be cost-saving for overall economic potential as long as screening cost less than $418.

Conclusion: The integration of a potentially cost-saving developmental screening program is acceptability, feasible, and potentially sustainable. Regular retraining, staff feedback, and referral resources may optimize integration.