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Improving Monitoring of Engagement in HIV Care for Women in Option B+: A Pilot Test of Biometric Fingerprint Scanning in Lilongwe, Malawi


Sustained engagement in HIV care is critical to the success of Option B+ for HIV-infected pregnant women. However, monitoring women’s engagement in care across clinics and over time is challenging due to migration and clinic transfers. Improved strategies to identify and monitor women’s engagement in HIV care across a network of clinics are needed, but have not been pilot tested. We evaluated the feasibility and acceptability of biometric fingerprint scanning to identify women and monitor HIV visit attendance among women in Option B+. Over a 3-month period, we enrolled HIV-infected pregnant women receiving care at two antenatal clinics in Lilongwe, Malawi and monitored their engagement in care using biometric fingerprint scanning and the standard-of-care electronic medical record (EMR) monitoring system. Biometric data was collected by trained research assistants, who uploaded and synced data across study sites daily using wireless internet. We collected data weekly on the biometric scanner performance, reliability, and usability. We assessed the feasibility and acceptability of using biometric fingerprint scanning to record HIV visits during exit interviews with a sample of participants and healthcare workers and by comparing visit concordance between the biometric fingerprint scanning and EMR systems. We enrolled 314 HIV-infected pregnant women and 51 HCWs (n = 365 total participants). The majority of participants felt the biometric fingerprint scanning system was easy to use (64%), required no additional assistance (69%) and met their expectations (76%). No major issues with data security, privacy, or scanner functionality were reported by HIV-infected women or healthcare workers. Of the 542 HIV visits captured during the study period among women in Option B+, 80% were recorded in the biometric fingerprint system versus 51% in the EMR system (PR 1.57, 95% CI 1.43, 1.72, p-value < 0.05). Among HIV-infected pregnant women engaged in HIV care, biometric fingerprint scanning is a feasible and acceptable way to monitor HIV visits and may improve the ability to monitor women’s engagement in HIV care over time and across clinics. Biometric fingerprint scanning should be scaled-up and evaluated as an implementation strategy to support sustained engagement in HIV care for women during the perinatal period.

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Data Accessibility

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.



Antenatal care


Antiretroviral therapy


Electronic medical record


Human immunodeficiency virus


Lost to follow-up


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The authors thank Phindile Simelane for her assistance with study coordination. We also thank the funders for their support of this project.


This work was supported by the National Institute of Mental Health [Grant Number R00MH112413] and the University of North Carolina at Chapel Hill Center for AIDS Research, funded by the National Institute of Allergy and Infectious Diseases (Grant number P30 AI50410). The funders did not have any role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.

Author information




AMB designed the study, conducted the data analysis, and helped to draft the paper; WK helped to design the study and draft the paper; PS and BK helped to oversee data collection. All authors critically reviewed the manuscript and helped to interpret the data analysis.

Corresponding author

Correspondence to Angela M. Bengtson.

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The authors declare that they have no competing interests.

Ethics Approval and Consent to Participate

All participants provided written informed consent and ethical approval was provided by the University of North Carolina (study number 17-1909) in the United States and the National Health Science Research Committee in Malawi (protocol 17/07/1868).

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Bengtson, A.M., Kumwenda, W., Lurie, M. et al. Improving Monitoring of Engagement in HIV Care for Women in Option B+: A Pilot Test of Biometric Fingerprint Scanning in Lilongwe, Malawi. AIDS Behav 24, 551–559 (2020).

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  • Biometrics
  • Biometric fingerprint scanning
  • Engagement in HIV care
  • Monitoring
  • HIV
  • Feasibility and acceptability