Point-of-Care Early Infant Diagnosis Improves Adherence to the Testing Algorithm in Kenya

Odhiambo, Collins; Githuka, George; Bowen, Nancy; Kingwara, Leonard; Onsase, Jared; Ochuka, Bernard; Waweru, Michael; Masaba, Rose; Matu, Lucy; Mwangi, Eliud; Cohn, Jennifer

doi:10.1177/2325958220906030

Cited by 2 publications

(1 citation statement)

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“…However, the average laboratory TAT was longer when only positive and indeterminate results, which were the focus of our study, were considered; 14.9% of these results were released after the required 96 h. The clinical TAT was also longer, with only 76.7% of results released within 96 h. The clinical TAT may thus require some revisions to enable the expedition of early infant diagnosis and ART initiation. Point-of-care HIV PCR testing has been shown to accomplish same-day diagnosis for infants, 28 with a significantly higher number of infants accessing confirmatory testing, 29 thereby assisting with rapid ART initiation.…”

Section: Discussionmentioning

confidence: 99%

Delays in HIV-1 infant polymerase chain reaction testing may leave children without confirmed diagnoses in the Western Cape province, South Africa

et al. 2022

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Background: Early diagnosis and confirmation of HIV infection in newborns is crucial for expedited initiation of antiretroviral therapy. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and HIV PCR test request rejections at National Health Laboratory Service laboratories in South Africa.Objective: This study assessed the metrics of routine infant HIV PCR testing at the Tygerberg Hospital Virology Laboratory, Cape Town, Western Cape, South Africa, including the proportion of rejected test requests, turn-around time (TAT), and rate of confirmatory testing.Methods: We retrospectively reviewed laboratory-based data on all HIV PCR tests performed on children ≤ 24 months old (n = 43 346) and data on rejected HIV PCR requests (n = 1479) at the Tygerberg virology laboratory over two years (2017–2019). Data from sample collection to release of results were analysed to assess the TAT and follow-up patterns.Results: The proportion of rejected HIV PCR requests was 3.3%; 83.9% of these were rejected for various pre-analytical reasons. Most of the test results (89.2%) met the required 96-h TAT. Of the reactive initial test results, 53.5% had a follow-up sample tested, of which 93.1% were positive. Of the initial indeterminate results, 74.7% were negative on follow-up testing.Conclusion: A high proportion of HIV PCR requests were rejected for pre-analytical reasons. The high number of initial reactive tests without evidence of follow-up suggests that a shorter TAT is required to allow confirmatory testing before children are discharged.

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Section: Discussionmentioning

confidence: 99%