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

Abstract

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.

Trends in uptake of early infant diagnosis for HIV: implementation results of the Ugandan military PMTCT program

“…21 While previous evidence from Low Income Countries have pointed to facility related factors such as the long turnaround time for receipt of PCR results and poor reliability of PCR machine hindering EID service delivery and leading to non-completion of the EID process by clients, the facilities in the current study have largely been supported by the program to ensure these challenges are addressed. 22,23 Therefore, we are able to rule out such challenges as explanation to the stagnated trend observed in our data. On the other hand, community and individual level factors including negative perceptions on the importance of EID, financial difficulties and denial of HIV status have in previous research been advanced to explain poor EID uptake and could explain the stagnated enrolment of mother-infant pairs observed in our data.…”

The Mentor-Mothers program in the Nigeria Department of Defense: Processes and Implementation

“…This is re ective of the numerous challenges in the provision of healthcare services and coverage of PMTCT of HIV in the country. Despite recording an improvement in the HIV prevalence of 1.4% among adults aged 15-49 years as compared to the previous estimate of 2.8%, in 2019, [2] report that only 32% of pregnant women living with HIV have access to antiretroviral drugs for PMTCT, with about 12% of HIV-exposed infants receiving HIV testing for early diagnosis by age 2 months in Nigeria. Several studies document that maximum adherence to ART is of extreme importance in achieving optimal viral load suppression to reduce the risk of mother-to-child transmission (MTCT) [3] Therefore the World Health Organization (WHO) in 2006 recommended "Task Shifting" as a means of initiating and managing more patients to meet the demand for antiretroviral therapy [4].…”

An urgent need for a paradigm shift in HIV testing for older children: A sine qua non condition to achieve an AIDS-free generation

“…This was due to the fact that during the study period, the HIV antibody rapid tests were readily available in the laboratory, unlike the DBS-PCR testing kits that were affected by the recurrent stock outs during that same period. The stock outs of PCR testing commodities had been previously reported as factors affecting the early infant diagnosis (EID) of HIV among neonates in sub-Saharan Africa countries(21,22). The use of point-of-care (PoC) HIV testing technology could address this gap and improve the turn-around time of EID results as well as the early ART initiation among HIV infected neonates(23–25).…”