Correlates of Suboptimal Entry Into Early Infant Diagnosis in Rural North Central Nigeria

Aliyu, Muktar H.; Blevins, Meridith; Megazzini, Karen; Audet, Carolyn M.; Dunlap, Julie; Sodangi, Ibrahim S.; Gebi, U; Shepherd, Bryan E.; Wester, C. William; Vermund, Sten H.

doi:10.1097/qai.0000000000000215

Cited by 8 publications

(10 citation statements)

References 31 publications

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“…Forty-three (62.3%) of these HEI received EID within two months of age; however it took an average of 5.6 months for results to be received. Aliyu et al reported EID enrollment as a function of DBS sample collection for infants of 712 HIV-infected women in North-Central Nigeria [38]. Only 357 women (50.1%) in their study cohort ever had DBS samples collected for their infants [38].…”

Section: Discussionmentioning

confidence: 99%

Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study

et al. 2019

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Background Early identification of HIV-infected infants for treatment is critical for survival. Efficient uptake of early infant diagnosis (EID) requires timely presentation of HIV-exposed infants, same-day sample collection, and prompt release of results. The MoMent (Mother Mentor) Nigeria study investigated the impact of structured peer support on EID presentation and maternal retention. This cascade analysis highlights missed opportunities for EID and infant treatment initiation during the study. Methods HIV-infected pregnant women and their infants were recruited at 20 rural Primary Healthcare Centers. Routine infant HIV DNA PCR testing was performed at centralized laboratories using dried blood spot (DBS) samples ideally collected by age two months. EID outcomes data were abstracted from study case report forms and facility registers. Descriptive statistics summarized gaps and missed opportunities in the EID cascade. Results Out of 497 women enrolled, delivery data was available for 445 (90.8%), to whom 415 of 455 (91.2%) infants were live-born. Out of 408 live-born infants with available data, 341 (83.6%) presented for DBS sampling at least once. Only 75.4% (257/341) were sampled, with 81.7% (210/257) sampled at first presentation. Only 199/257 (77.4%) sampled infants had results available up to 28 months post-collection. Two (1.0%) of the 199 infants tested HIV-positive; one infant died before treatment initiation and the other was lost to follow-up. Conclusions While nearly 85% of infants presented for sampling, there were multiple missed opportunities, largely due to health system and not necessarily patient-level failures. These included infants presenting without being sampled, presenting multiple times before samples were collected, and getting sampled but results not forthcoming. Finally, neither of the two HIV-positive infants were linked to treatment within the follow-up period, which may have led to the death of one. To facilitate patient compliance and HIV-free infant survival, quality improvement approaches should be optimized for EID commodity availability, consistent DBS sample collection, efficient processing/result release, and prompt infant treatment initiation.

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Section: Discussionmentioning

confidence: 99%

Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study

et al. 2019

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“…And in the same year, only 3.9% of exposed infants received a PCR diagnostic test within two months of birth [14] . This low level of diagnosis among HIV-exposed infants falls below the national target of ensuring that at least 90% of all HIV exposed infants have access to early diagnosis services by 2015 [5] . Especially with an estimated 52125 to 104250 infants at risk of being infected with HIV without intervention [15] .…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that only 0.5% to 52.8% of infants eligible for early infant diagnosis (EID) testing in RLS complete the care cascade and eventually access treatment [22] . Therefore, strategies for improving patient retention should be a critical focus of PMTCT programs with respect to the UNAIDS 90-90-90 targets [5] . A review of the PMTCT cascade is essential to identify gaps towards achieving the goals of PMTCT services [24] .…”

Section: Introductionmentioning

confidence: 99%

“…PMTCT programs can reduce the risk of MTCT to less than 2%, and is today the most efficacious tool for preventing pediatric HIV infection globally [2][3][4][5] . PMTCT programs have witnessed appreciable success in Nigeria with documented MTCT rates ranging from 1.3%-4.8% in mother-baby pairs who received antiretroviral therapy (ART), compared to MTCT rates ranging from 39.8%-68.0% where no intervention was administered [6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

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Active tracking of rejected dried blood samples in a large program in Nigeria

Inalegwu¹,

Phillips²,

Datir³

et al. 2016

WJV

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“…Recent studies have shown that average age of ART initiation among HIV-infected infants diagnosed through EID services ranges widely, from 2 months to as long as 11 months. 14-18 Retaining HIV-exposed infants in care, returning HIV test results to their caregivers, and providing early ART to HIV-infected infants continue to be major challenges for prevention of mother-to-child HIV transmission (PMTCT) and pediatric HIV programs. 19 …”

Section: Introductionmentioning

confidence: 99%

Optimizing Infant HIV Diagnosis in Resource-Limited Settings: Modeling the Impact of HIV DNA PCR Testing at Birth

Chiu

Modi

Rivadeneira³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Early antiretroviral therapy (ART) initiation in HIV-infected infants significantly improves survival but is often delayed in resource-limited settings. Adding HIV testing of infants at birth to the current recommendation of testing at age 4–6 weeks may improve testing rates and decrease time to ART initiation. We modeled the benefit of adding HIV testing at birth to the current 6-week testing algorithm. Methods Microsoft Excel was used to create a decision-tree model of the care continuum for the estimated 1,400,000 HIV-infected women and their infants in sub-Saharan Africa in 2012. The model assumed average published rates for facility births (42.9%), prevention of mother-to-child HIV transmission utilization (63%), mother-to-child-transmission rates based on prevention of mother-to-child HIV transmission regimen (5%–40%), return of test results (41%), enrollment in HIV care (52%), and ART initiation (54%). We conducted sensitivity analyses to model the impact of key variables and applied the model to specific country examples. Results Adding HIV testing at birth would increase the number of infants on ART by 204% by age 18 months. The greatest increase is seen in early ART initiations (543% by age 3 months). The increase would lead to a corresponding increase in survival at 12 months of age, with 5108 fewer infant deaths (44,550, versus 49,658). Conclusion Adding HIV testing at birth has the potential to improve the number and timing of ART initiation of HIV-infected infants, leading to a decrease in infant mortality. Using this model, countries should investigate a combination of HIV testing at birth and during the early infant period.

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Correlates of Suboptimal Entry Into Early Infant Diagnosis in Rural North Central Nigeria

Cited by 8 publications

References 31 publications

Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study

Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study

Active tracking of rejected dried blood samples in a large program in Nigeria

Optimizing Infant HIV Diagnosis in Resource-Limited Settings: Modeling the Impact of HIV DNA PCR Testing at Birth

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