Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions

Abstract

Early infant diagnosis (EID) of HIV-1 infection confers substantial benefits to HIV-infected and HIV-uninfected infants, to their families, and to programs providing prevention of mother-to-child transmission (PMTCT) services, but has been challenging to implement in resource-limited settings. In order to correctly inform parents/caregivers of infant infection status and link HIV-infected infants to care and treatment, a 'cascade' of events must successfully occur. A frequently cited barrier to expansion of EID programs is the cost of the required laboratory assays. However, substantial implementation barriers, as well as personnel and infrastructure requirements, exist at each step in the cascade. In this update, we review challenges to uptake at each step in the EID cascade, highlighting that even with the highest reported levels of uptake, nearly half of HIV-infected infants may not complete the cascade successfully. We next synthesize the available literature about the costs and cost effectiveness of EID programs; identify areas for future research; and place these findings within the context of the benefits and challenges to EID implementation in resource-limited settings.

Low-cost tools for diagnosing and monitoring HIV infection in low-resource settings

“…35 Current p24 immunoassays have better sensitivity over past-generation p24 tests because of the inclusion of a heat-denaturation step for separating p24-antibody complexes that commonly interfere with assay sensitivity. Many studies support the use of the Perkin Ultra p24 immunoassay for early diagnosis in infants aged 10 days to 12 months.…”

“…43 Early infant diagnosis test kits alone may cost up to 55% of the overall price of test-related materials. 35 Policy …”

Point of care testing of HIV in children younger than 18 months with three different HIV virological assays. Experience from a district hospital in a resource-limited setting

“…3 In fact, previous studies have reported false negative HIV DNA PCR tests in children infected by non-B HIV-1 subtypes. [12][13][14][15] In American guidelines for ART in paediatric HIV infection, 16 it is recommended to use HIV RNA PCR assays for confirming negative HIV DNA PCR tests when a non-B HIV-1 subtype is suspected because of the improved sensitivity of the RNA PCR assays for these subtypes.…”

“…2 However, diagnosis of HIV in children younger than 18 months can be challenging in resource-limited setting. 3 HIV transmission from mother to child can occur in the uterus, during delivery or during breastfeeding. 4 Because of the passage of maternal antibodies through the placenta to the foetus, HIV serological testing is not useful for the diagnosis of HIV infection in children younger than 18 months.…”

Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings

“…The centralized structure leads to significant delay (also called turnaround time) between collection of samples and receipt of results at the health facility (Nuwagaba-Biribonwoha et al 2010, Creek et al 2008, Khamadi et al 2008. Long turnaround time (TAT), can adversely impact patient health outcomes because of high mortality rate (Newell et al 2004) and reduced likelihood of collection of results by mothers (or other caregivers) of infants (Latigo-Mugambi et al 2013, NuwagabaBiribonwoha et al 2010, Ciaranello et al 2011, Chatterjee et al 2011.…”