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

Chiu, Alexander; Modi, Surbhi; Rivadeneira, Emilia; Koumans, Emilia H.

doi:10.1097/qai.0000000000001126

Cited by 12 publications

(9 citation statements)

References 43 publications

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“…According to the Kenya prevention of mother-to-child transmission (PMTCT) guidelines, HIV diagnosis of HEIs is made by a positive virological test using deoxyribonucleic acid polymerase chain reaction (DNA-PCR) test at 6 weeks or as early as possible thereafter. 4 …”

Section: Methodsmentioning

confidence: 99%

Epidemiology of HIV Infection Among HIV-Exposed Infants, Nairobi County, Kenya, 2015

et al. 2020

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Objective: To characterize human immunodeficiency virus (HIV)-positive infants among HIV-exposed infants (HEIs) in Nairobi County for public health action. Methods: We conducted a retrospective review of records of HEIs’ HIV polymerase chain reaction (PCR) results in Nairobi County in 2015, excluding confirmatory PCR-positive results. HIV-exposed infant registry data were entered into Microsoft Excel and descriptive and associative statistics were calculated with OpenEpi software. Results: A total of 5802 HEI records were analyzed, with a median age of 4.5 (interquartile range, 8.5) months; 342 (5.9%) tested positive, 51% were female, and 4420 (76.2%) were seen at maternal and child health clinics. Standard highly active antiretroviral therapy intervention was given to 184 (60.3%) of the mothers of exposed infants, and 178 (53%) of the HIV-positive infants received active antiretroviral therapy. A total of 3464 (59.7%) HEIs had PCR done within the first 2 months, and 119 (3.4%) tested positive. The average turnaround time for PCR samples was 28 ± 22 days, and a total of 191 (3.3%) HIV-positive HEIs were exclusively breastfed for the first 6 months of life. Conclusion: The recorded mother-to-child transmission (MTCT) rate of 5.9% in Nairobi County is lower than the 2015 national rate, which suggests the Nairobi prevention of mother-to-child transmission efforts are moderately effective. However, results from this study show that Kenya will struggle to meet the MTCT 2020 target rate of <5%.

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Section: Methodsmentioning

confidence: 99%

Epidemiology of HIV Infection Among HIV-Exposed Infants, Nairobi County, Kenya, 2015

et al. 2020

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“…1 The highest mortality in an infant who has acquired HIV is between the ages of 6 weeks to 4 months; therefore, early infant diagnosis is imperative in identifying the status of the infant for early introduction of treatment. 1,2,3,4 A South African trial conducted in HIV-positive infants showed improved short-term neurodevelopmental outcomes because of early initiation of ART, in comparison to infants for whom treatment was delayed. 5 Violari et al 6 found that infant mortality was reduced by 76% and HIV progression by 75% when infants infected with HIV were diagnosed and placed on ART before 12 weeks of age.…”

Section: Introductionmentioning

confidence: 99%

HIV testing at birth: Are we getting it right?

Bisschoff

Coulon

Isaacs

et al. 2019

Southern African Journal of HIV Medicine

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Background Birth polymerase chain reaction (PCR) testing improves early detection of HIV and allows for early treatment initiation. National guidelines exist, but it is unknown whether these are being implemented correctly. Objectives To determine whether HIV-exposed infants at the Mangaung University Community Partnership Programme Community Health Centre (MUCPP CHC) received PCR tests at birth, if HIV-positive infants were initiated on treatment, if follow-up dates were scheduled and the percentage of mothers or caregivers who returned to collect the results. Methods The study was a retrospective descriptive file audit (1304 files) of births from 01 January to 31 December 2016 at MUCPP CHC. The study sample was 428 infants born to HIV-positive mothers. The birth register was used to collect the infants’ HIV PCR test barcodes. The birth and 10-week PCR results were retrieved from an electronic database at the Virology Department, University of the Free State. Results In total, 375 infants received a birth PCR test (87.6%) of which 4 (1.1%) tested HIV positive and 327 (87.2%) negative. Follow-up tests were not scheduled. However, 145 (44.3%) HIV-negative infants returned for a 10-week test. Irrespective of the PCR birth result, 157 (36.7%) infants were brought for a 10-week follow-up test at which time 3 (1.9%) tested positive and 151 (96.2%) negative. Conclusion The majority of HIV-exposed infants received a PCR test at birth; however, the clinic is below the national target (90%) for HIV testing. A record-keeping system of infants’ visits does not exist at MUCPP CHC, making it impossible to determine whether HIV-positive infants were started on antiretroviral treatment.

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“…Prompt initiation of HIV infected infants on ART increases their chances of survival [ 23 ], therefore delaying infant testing until six weeks may result in late ART initiation. Another study also found that HIV infected infants who tested at birth, obtained their PCR results earlier and were able to start ART earlier as compared to those who tested at six weeks [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the delivery and uptake of early infant diagnosis of HIV services in Greater Accra, Ghana: A qualitative study

Ankrah

Dako-Gyeke

2021

PLoS ONE

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Background Early Infant Diagnosis (EID) of HIV and timely initiation of Antiretroviral Therapy (ART) can significantly reduce morbidity and mortality of HIV infected infants. Despite the benefits of early infant testing, the coverage of EID of HIV services is still low in Sub-Saharan Africa, including Ghana. Objectives To ascertain the factors that facilitate or hinder the delivery and uptake of EID of HIV services. Methods The study is a cross-sectional exploratory qualitative research conducted in two health facilities in the Greater Accra Region of Ghana. Respondents (n = 50) comprising health workers (n = 20) and HIV positive mothers (n = 30) were purposively sampled and engaged in in-depth interviews. The Nvivo 11 software and the Braun and Clarke’s stages of thematic analysis were used in coding data and data analysis respectively. Results The study found that health system factors such as inadequate Staff with sample collection skills, unavailability of vehicles to convey samples to the reference laboratory for analysis, the long turnaround time for receipt of Polymerase Chain Reaction (PCR) results, inadequate and frequent breakdown of PCR machine hindered EID service delivery. On the other hand, adequate knowledge of health workers on EID, availability of Dried Blood Spot (DBS) cards and the adoption of task shifting strategies facilitated EID service delivery. Factors such as the denial of HIV status, non-completion of the EID process due to frustrations encountered whiles accessing service and delay in receipt of PCR results served as barriers to mother’s utilisation of EID services for their exposed infants. The study also identified that adequate knowledge of EID, perceived importance of EID, financial stability as well as financial support from others and the positive attitudes of health workers facilitated HIV positive mother’s uptake of EID services for their exposed infants. Conclusion The factors attributing to the low coverage of EID of HIV services must be promptly addressed to improve service delivery and uptake.

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

Cited by 12 publications

References 43 publications

Epidemiology of HIV Infection Among HIV-Exposed Infants, Nairobi County, Kenya, 2015

Epidemiology of HIV Infection Among HIV-Exposed Infants, Nairobi County, Kenya, 2015

HIV testing at birth: Are we getting it right?

Factors influencing the delivery and uptake of early infant diagnosis of HIV services in Greater Accra, Ghana: A qualitative study

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