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

Background: Children with perinatal HIV exposure are at increased risk for neurodevelopmental (ND) delays, yet little is known about ND screening implementation for this population. Methods: This 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. Results: Of 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. Conclusions: ND 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.