Early infant diagnosis of HIV infection in low-income and middle-income countries: does one size fit all?

Penazzato, Martina; Revill, Paul; Prendergast, Andrew J.; Collins, Intira Jeannie; Walker, Simon; Elyanu, Peter; Sculpher, Mark; Gibb, Diana

doi:10.1016/s1473-3099(13)70262-7

Cited by 39 publications

(39 citation statements)

References 30 publications

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“…It is unclear to what extent older HIV-infected children are still outside HIV care; although guidelines include International Health provider-initiated counselling and testing, in practice this is often missed. 23 Although numbers were small, the majority of the children in care attended Kalongo Hospital for ART, and some carers cited fear of drug stock-outs as the reason for not accessing ART locally; previous work has suggested that stockouts of paediatric ART may be more frequent than of adult ART. 24 Post-decentralisation, over two-thirds of the population reported the local primary care facility as the nearest facility where one could receive ART, although fewer participants were aware of local ART availability in the villages furthest from the health facility, suggesting community engagement could still be improved.…”

Section: Discussionmentioning

confidence: 99%

Impact of decentralisation of antiretroviral therapy services on HIV testing and care at a population level in Agago District in rural Northern Uganda: results from the Lablite population surveys

Abongomera

Kiwuwa-Muyingo

Revill

et al. 2017

International Health

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Background: We conducted unlinked cross-sectional population-based surveys in Northern Uganda before and after antiretroviral therapy (ART) provision (including Option B+ [lifelong ART for pregnant/breast-feeding women]) at a local primary care facility (Lira Kato Health Centre [HC]). Prior to decentralisation, people travelled 56-76 km round-trip for ART; we aimed to evaluate changes in uptake of HIV-testing, ART coverage and access to ART following decentralisation.Methods: A total of 2124 adults in 1351 households in two parishes closest to Lira Kato HC were interviewed using questionnaires between March and April 2013 and 2123 adults in 1229 households between January and March 2015.Results: Adults reporting HIV-testing in the last year increased from 1077/2124 (50.7%) to 1298/2123 (61.1%) between surveys (p<0.001). ART coverage increased from 74/136 (54.4%) self-reported HIV-positive adults in 2013 to 108/133 (81.2%) in 2015 (p<0.001). Post-decentralisation, 47/108 (43.5%) of those on ART were in care at Lira Kato HC (including 37 new initiations). Most of the remainder (47/61, 77%) started ART prior to any ART provision at Lira Kato HC; the most common reason given for not accessing ART locally was concern about drug-stock-outs (30/59, 51%).Conclusions: HIV-testing and ART coverage increased after decentralisation combined with Option B+ roll-out. However, patients on ART before decentralisation were reluctant to transfer to their local facility.

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Section: Discussionmentioning

confidence: 99%

Impact of decentralisation of antiretroviral therapy services on HIV testing and care at a population level in Agago District in rural Northern Uganda: results from the Lablite population surveys

Abongomera

Kiwuwa-Muyingo

Revill

et al. 2017

International Health

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“…Linkage to care from these services in resourcelimited settings and countries has traditionally been poor [5][6][7]. According to the WHO GAP report, 58% of HIV-exposed infants in low and middle-income countries failed to be tested within 2 months of birth [8].…”

Section: Making the Diagnosis And Linking To Carementioning

confidence: 99%

An update on the HIV treatment cascade in children and adolescents

Bobat

Archary²,

Lawler³

2015

Current Opinion in HIV and AIDS

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“…Indeed, in Zambia, there are only three facilities with laboratories capable of processing PCR [11]. The situation is also exacerbated by restriction of sample collection sites to PMTCT clinics, stock outs of HIV testing commodities, poorly functioning sample transport networks, and limitations in supply chain management [8, 12, 13]. Current efforts are underway to address these acknowledged problems, including, for example, point-of-care technologies [12].…”

Section: Introductionmentioning

confidence: 99%

Barriers to uptake of early infant HIV testing in Zambia: the role of intimate partner violence and HIV status disclosure within couples

2017

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BackgroundEarly detection of pediatric HIV through uptake of infant HIV testing is critical for access to treatment and child survival. While structural barriers have been well described, a greater understanding of social and behavioral factors that may relate to maternal uptake of early infant HIV testing services is urgently needed. The aim of this study was to explore how gender power dynamics within couples affect HIV-positive women’s uptake of early infant HIV testing at a large health center in Lusaka, Zambia.MethodsIn 2014, 320 HIV-positive married postpartum women were recruited at a large public health facility in Lusaka to participate in a cross-sectional survey. Data on uptake of early infant HIV testing by 4–6 weeks of age was collected through medical records. Simple and multiple logistic regression models determined significant predictors of maternal uptake of early infant HIV testing.ResultsIn the adjusted model, uptake of early infant HIV testing was associated with female-directed emotional intimate partner violence (aOR 0.41; 95% CI 0.21–0.79; p < 0.01), HIV status disclosure to the male partner (aOR 13.73, 95% CI 3.59–52.49, p < 0.001), and maternal postpartum ART adherence (aOR 2.28, 95% CI 1.15–4.55, p < 0.05).ConclusionsDomestic relationship dynamics, including emotional violence and HIV status disclosure to the male partner, may play an important role in maternal uptake of early infant HIV testing. These findings provide additional evidence for the link between intimate partner violence against women and poor HIV-related health outcomes. Programs that adequately screen for and address various forms of intimate partner violence within the context of prevention of mother-to-child transmission are recommended.

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Early infant diagnosis of HIV infection in low-income and middle-income countries: does one size fit all?

Cited by 39 publications

References 30 publications

Impact of decentralisation of antiretroviral therapy services on HIV testing and care at a population level in Agago District in rural Northern Uganda: results from the Lablite population surveys

Impact of decentralisation of antiretroviral therapy services on HIV testing and care at a population level in Agago District in rural Northern Uganda: results from the Lablite population surveys

An update on the HIV treatment cascade in children and adolescents

Barriers to uptake of early infant HIV testing in Zambia: the role of intimate partner violence and HIV status disclosure within couples

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