Cost-Effectiveness of Routine Rapid Human Immunodeficiency Virus Antibody Testing Before DNA-PCR Testing for Early Diagnosis of Infants in Resource-Limited Settings

Abstract

Screening infants with RHT before DNA-PCR is cost-effective in infants 3 months old or older. Incorporating RHT into early infant testing programs could improve cost-effectiveness and reduce program costs.

Universal HIV Screening at Postnatal Points of Care: Which Public Health Approach for Early Infant Diagnosis in Côte d'Ivoire?

“…Screening infants with rapid HIV testing before DNA-PCR, as we did in our study, was shown to be cost-effective in infants aged three months or older in Uganda. Incorporating rapid HIV tests into early infant testing programs could improve cost-effectiveness and reduce program costs [39], [42], [43].…”

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

“…Active tracking of HIV positive mothers using support groups and mobile applications have also been shown to increase uptake of services and retention of the mother-baby pair in PMTCT programs [41,43,44] . Establishing an accurate link between rejected samples and the impact on clinical outcome is difficult [32] . However, the observed high rejection and low repeat rates in addition to the higher mean age of infants at the time of specimen recollection in this study suggest that sample rejection further delays HIV diagnosis in infants while emphasizing the importance of standardization and monitoring of pre-analytical variables [30] .…”

“…Pre-analytical errors contribute an estimated 60%-70% of all mistakes in laboratory diagnostics and can render dried blood spots (DBS) untestable, leading to specimen rejection with a resultant negative impact on patients [29][30][31] . Common pre-analytical errors associated with DBS rejection include: Labeling errors, sample damage, missing or inconsistent data, and insufficient volume [32][33][34][35] . High risk for rapid disease progression and death necessitates the need for early identification and treatment of HIV positive infants [36] .…”

Breastfeeding, Mother-to-Child HIV Transmission, and Mortality Among Infants Born to HIV-Infected Women on Highly Active Antiretroviral Therapy in Rural Uganda

“…Children under 18 months of age were tested by both antibody testing and HIV DNA or RNA PCR as part of a separate study. 13 Children 18 months old and older were tested by antibody testing only. All infant testing required the mother to bring their infant to the RCT study clinic for bleeding.…”