Early Diagnosis of HIV Infection in Infants — One Caribbean and Six Sub-Saharan African Countries, 2011–2015

Diallo, Karidia; Aa, Kim; Lecher, Shirley Lee; Ellenberger, Dennis; Rs, Beard; Dale, Helen; Hurlston, Mackenzie; Rivadeneira, María Fernanda; Pn, Fonjungo; Ln, Broyles; Zhang, G; Sleeman, Katrina; Nguyen, Shon; Jadczak, Stephen; Abiola, Nadine; Ewetola, Raimi; Muwonga, Jérémie; Fwamba, Franck; Mwangi, Christina; Naluguza, Mary; Kiyaga, Charles; Ssewanyana, Isaac; Varough, D; Wysler, D; Lowrance, David; Fj, Louis; Désinor, Olbeg; Buteau, Josiane; Kesner, F; Rouzier,; Segaren, N.; Lewis, Todd P.; Sarr, Abdoulaye; Chipungu, Geoffrey; Gupta, Sourabh; D, Singer; Mwenda, Reuben; Kapoteza, H; Chipeta, Zawadi; Knight, Nicole A; Carmona, Sergio; Macleod, W. Bentley; Sherman, Gayle; Pillay, Yogan; Ndongmo, Clement B.; Mugisa, Bridget; Mwila, Annie; McAuley, James B.; Pj, Chipimo; Kaonga, W; Nsofwa, D; Nsama, D; Fz, Mwamba; Moyo, C; Phiri, Caroline; My, Borget; Ya-Kouadio, L; Kouame, A; Ca, Adje-Toure; Nkengasong, John N.

doi:10.15585/mmwr.mm6546a2

Cited by 31 publications

(23 citation statements)

References 6 publications

(6 reference statements)

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“…Our findings of timely testing are comparable with the global WHO figures (43%) and studies conducted elsewhere in Africa and Asia. The timely uptake ranged from 62% in Namibia, 40% in Thailand and 34% in Haiti [4,14,15]. Around 22% of the HIV-exposed babies were enrolled after eight weeks of birth (data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…However, it was lesser than seven to ten weeks in Mozambique, 39 weeks in rural Tanzania and 13 weeks in rural Zambia [8,14,17–21]. Long TAT may be due to dependence on public transportation for transfer of samples to PHL and communication of test results to the ART center, sample waiting time at PHL and the distance between ART center and PHL (median 128 km).…”

Section: Discussionmentioning

confidence: 99%

“…Similar innovative ideas to communicate EID results, like global package radio service printers [17], and use of courier services for transporting samples may be implemented systematically. Fourth, EID services should be integrated at multiple entry points – antenatal care clinics, immunization clinics, and other baby care centers and not just be available in ART centers [14,23]. Fifth, resources for hiring and training additional technicians for pediatric blood sampling should be considered.…”

Section: Discussionmentioning

confidence: 99%

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Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time

Thiha¹,

Shewade²,

Philip

et al. 2017

Global Health Action

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Background: In collaboration with the national AIDS program, early infant diagnosis (EID) is implemented by Integrated HIV Care (IHC) program through its anti-retroviral therapy (ART) centers across 10 cities in five states and regions of Myanmar. Blood samples from the ART centers are sent using public transport to a centralized PCR facility. Objectives: Among HIV-exposed babies <9 months at enrolment into IHC program (2013–15), to describe the EID cascade (enrolment, sample collection for PCR, result receipt by mother, HIV diagnosis and ART initiation) and factors associated with delayed (>8 weeks of age) or no blood sample collection for EID. Methods: Retrospective cohort study involving record review. A predictive poisson regression model with robust variance estimates was fitted for risk factors of delayed or no sample collection. Results: Of 1349 babies, 523 (39%) of the babies’ mothers were on ART before pregnancy. Timely uptake of EID (<8 weeks of age) was 47% (633/1349); sample collection was delayed in 27% (367/1349) and not done in 26% (349/1349) babies. Among samples collected (n = 1000), 667 results were received by the mother; 52 (5%) were HIV-infected; among them 42 (81%) were initiated on ART. Median (IQR) turnaround time from sample collection to result receipt by mother and time to initiate ART from result receipt by mother was 7 (4,12) and 8.5 (6,16) weeks, respectively. Mothers not on ART before pregnancy and distance of ART center from PCR facility (more than 128 km) were the risk factors of delayed or no sample collection. Conclusions: Improving provision of ART to mothers (through universal ‘test and treat’) is urgently required, which has the potential to improve the timely uptake of EID as well. Interventions to reduce turnaround times, like point of care EID testing and/or systematic use of mobile technology to communicate results, are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time

Thiha¹,

Shewade²,

Philip

et al. 2017

Global Health Action

View full text Add to dashboard Cite

show abstract

“…The most common difficulties in accessing EID tests were those encountered in the transport of specimens, the long delay between specimen collection and receipt of results, and the limitations of supply chain management [24]. In our study, the total time between the date of collection and return of PCR results in the records was 68 days (for an average of 105,5 days, depending on health professionals), with an initial standard of 14 days.…”

Section: Results Of Hiv Early Infant Diagnosismentioning

confidence: 72%

“…While EID is the key to early initiation of HAART and the reduction of mortality associated with HIV infection, the authors emphasize the complexity of translating the results of clinical trials and WHO guidelines into the practice, initiation of ART is often slow [14,22,23]. During 2011-2015, the total number of HIV diagnostic tests performed among HIV-exposed infants within 6 weeks after birth increased in the seven PEPFAR countries studied, however, the rate of testing for EID among HIV-exposed infants was less than 50% in five countries in 2015 [24].…”

Section: Results Of Hiv Early Infant Diagnosismentioning

confidence: 99%

Assessment of the Early Infant Diagnosis of HIV Infection in Togo in 2014

Azoumah¹,

Agbeko²,

Kar³

et al. 2017

J AIDS Clin Res

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Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Peter¹,

Zeh²,

Katz

et al. 2017

J Intern AIDS Soc

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IntroductionThe scale‐up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point‐of‐care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low‐resource countries. The purpose of this commentary is to review the challenges and solutions from the large‐scale implementation of other diagnostic tests, namely nucleic‐acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale‐up of VL.DiscussionExperience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale‐up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow‐up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business.ConclusionsThe lessons and innovations from large‐scale EID and CD4 programs described here can be adapted to inform more effective scale‐up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost‐effective test access.

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Early Diagnosis of HIV Infection in Infants — One Caribbean and Six Sub-Saharan African Countries, 2011–2015

Cited by 31 publications

References 6 publications

Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time

Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time

Assessment of the Early Infant Diagnosis of HIV Infection in Togo in 2014

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

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