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Nkenfou CN, Nguefack-Tsague G, Nanfack AJ, Moudourou SA, Ngoufack MN, Yatchou LG, Elong EL, Kameni JJ, Tiga A, Kamgaing R, Kamgaing N, Fokam J, Ndjolo A. Strategic HIV Case Findings among Infants at Different Entry Points of Health Facilities in Cameroon: Optimizing the Elimination of Mother-To-Child Transmission in Low- and- Middle-Income Countries. Viruses 2024; 16:752. [PMID: 38793633 PMCID: PMC11125675 DOI: 10.3390/v16050752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought to determine HIV positivity rates among children according to entry points in Cameroon. METHODS A facility-based survey was conducted from January 2015 to December 2019 among mother-child couples at various entry points of health facilities in six regions of Cameroon. A questionnaire was administered to parents/guardians. Children were tested by polymerase chain reaction (PCR). Positivity rates were compared between entry points. Associations were quantified using the unadjusted positivity ratio (PR) for univariate analyses and the adjusted positivity ratio (aPR) for multiple Poisson regression analyses with 95% confidence intervals (CIs). p-values < 0.05 were considered significant. RESULTS Overall, 24,097 children were enrolled. Among them, 75.91% were tested through the HIV prevention of mother-to-child transmission (PMTCT) program, followed by outpatient (13.27%) and immunization (6.27%) services. In total, PMTCT, immunization, and outpatient services accounted for 95.39% of children. The overall positivity was 5.71%, with significant differences (p < 0.001) between entry points. Univariate analysis showed that inpatient service (PR = 1.45; 95% CI: [1.08, 1.94]; p = 0.014), infant welfare (PR = 0.43; 95% CI: [0.28, 0.66]; p < 0.001), immunization (PR = 0.56; 95% CI: [0.45, 0.70]; p < 0.001), and PMTCT (PR = 0.41; 95% CI: [0.37, 0.46]; p < 0.001) were associated with HIV transmission. After adjusting for other covariates, only PMTCT was associated with transmission (aPR = 0.66; 95% CI: [0.51, 0.86]; p = 0.002). CONCLUSIONS While PMTCT accounts for most tested children, high HIV positivity rates were found among children presenting at inpatient, nutrition, and outpatient services and HIV care units. Thus, systematic HIV testing should be proposed for all sick children presenting at the hospital who have escaped the PMTCT cascade.
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Affiliation(s)
- Celine Nguefeu Nkenfou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Higher Teacher Training College, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon
| | - Georges Nguefack-Tsague
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
| | - Aubin Joseph Nanfack
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Sylvie Agnes Moudourou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | | | - Leaticia-Grace Yatchou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Elise Lobe Elong
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Joel-Josephine Kameni
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Aline Tiga
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Rachel Kamgaing
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Nelly Kamgaing
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
- Faculty of Health Sciences, University of Buea, Buea P.O. Box 63, Cameroon
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
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Ochodo EA, Guleid F, Deeks JJ, Mallett S. Point-of-care tests detecting HIV nucleic acids for diagnosis of HIV-1 or HIV-2 infection in infants and children aged 18 months or less. Cochrane Database Syst Rev 2021; 8:CD013207. [PMID: 34383961 PMCID: PMC8406580 DOI: 10.1002/14651858.cd013207.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The standard method of diagnosing HIV in infants and children less than 18 months is with a nucleic acid amplification test reverse transcriptase polymerase chain reaction test (NAT RT-PCR) detecting viral ribonucleic acid (RNA). Laboratory testing using the RT-PCR platform for HIV infection is limited by poor access, logistical support, and delays in relaying test results and initiating therapy in low-resource settings. The use of rapid diagnostic tests at or near the point-of-care (POC) can increase access to early diagnosis of HIV infection in infants and children less than 18 months of age and timely initiation of antiretroviral therapy (ART). OBJECTIVES To summarize the diagnostic accuracy of point-of-care nucleic acid-based testing (POC NAT) to detect HIV-1/HIV-2 infection in infants and children aged 18 months or less exposed to HIV infection. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (until 2 February 2021), MEDLINE and Embase (until 1 February 2021), and LILACS and Web of Science (until 2 February 2021) with no language or publication status restriction. We also searched conference websites and clinical trial registries, tracked reference lists of included studies and relevant systematic reviews, and consulted experts for potentially eligible studies. SELECTION CRITERIA We defined POC tests as rapid diagnostic tests conducted at or near the patient site. We included any primary study that compared the results of a POC NAT to a reference standard of laboratory NAT RT-PCR or total nucleic acid testing to detect the presence or absence of HIV infection denoted by HIV viral nucleic acids in infants and children aged 18 months or less who were exposed to HIV-1/HIV-2 infection. We included cross-sectional, prospective, and retrospective study designs and those that provided sufficient data to create the 2 × 2 table to calculate sensitivity and specificity. We excluded diagnostic case control studies with healthy controls. DATA COLLECTION AND ANALYSIS We extracted information on study characteristics using a pretested standardized data extraction form. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool to assess the risk of bias and applicability concerns of the included studies. Two review authors independently selected and assessed the included studies, resolving any disagreements by consensus. The unit of analysis was the participant. We first conducted preliminary exploratory analyses by plotting estimates of sensitivity and specificity from each study on forest plots and in receiver operating characteristic (ROC) space. For the overall meta-analyses, we pooled estimates of sensitivity and specificity using the bivariate meta-analysis model at a common threshold (presence or absence of infection). MAIN RESULTS We identified a total of 12 studies (15 evaluations, 15,120 participants). All studies were conducted in sub-Saharan Africa. The ages of included infants and children in the evaluations were as follows: at birth (n = 6), ≤ 12 months (n = 3), ≤ 18 months (n = 5), and ≤ 24 months (n = 1). Ten evaluations were field evaluations of the POC NAT test at the point of care, and five were laboratory evaluations of the POC NAT tests.The POC NAT tests evaluated included Alere q HIV-1/2 Detect qualitative test (recently renamed m-PIMA q HIV-1/2 Detect qualitative test) (n = 6), Xpert HIV-1 qualitative test (n = 6), and SAMBA HIV-1 qualitative test (n = 3). POC NAT pooled sensitivity and specificity (95% confidence interval (CI)) against laboratory reference standard tests were 98.6% (96.1 to 99.5) (15 evaluations, 1728 participants) and 99.9% (99.7 to 99.9) (15 evaluations, 13,392 participants) in infants and children ≤ 18 months. Risk of bias in the included studies was mostly low or unclear due to poor reporting. Five evaluations had some concerns for applicability for the index test, as they were POC tests evaluated in a laboratory setting, but there was no difference detected between settings in sensitivity (-1.3% (95% CI -4.1 to 1.5)); and specificity results were similar. AUTHORS' CONCLUSIONS For the diagnosis of HIV-1/HIV-2 infection, we found the sensitivity and specificity of POC NAT tests to be high in infants and children aged 18 months or less who were exposed to HIV infection.
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Affiliation(s)
- Eleanor A Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fatuma Guleid
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Mallett
- UCL Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
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3
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Ngoufack MN, Nkenfou CN, Atogho Tiedeu B, Mouafo LCM, Dambaya B, Ndzi EN, Kouanfack C, Nguefack-Tsague G, Mbacham WF, Ndjolo A. CCR2 Genetic Polymorphism And Its Potential Effect On HIV Acquisition In A Population Of Children Living In The Northern Region Of Cameroon. APPLICATION OF CLINICAL GENETICS 2019; 12:229-234. [PMID: 31819589 PMCID: PMC6886552 DOI: 10.2147/tacg.s202498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/28/2019] [Indexed: 11/26/2022]
Abstract
Background and objectives The association of chemokine receptor-2 (CCR2) polymorphism with HIV transmission or disease progression remains highly controversial. The role of CCR2-64I allele in HIV infection may differ from one population to another because of their genetic background. The objectives of this study were to characterize the CCR2 genetic polymorphism and to determine its potential effect in HIV acquisition in children living in the Northern Region of Cameroon. Materials and methods A cross-sectional study was carried out in five health facilities in the Northern region of Cameroon. DNA was extracted from the Buffy coat of each participant using the QIAamp®DNA mini kit. The DNA extract was then subjected to polymorphic analyses. CCR2 genotypes were analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). The Chi-Squared test was used for the assessment of the Hardy-Weinberg equilibrium. Results A total of 134 children under 15 years comprised of 38 HIV-exposed infected (28.36%) and 96 HIV-exposed un-infected (71.64%) participants were recruited. Prevalences of 44.78% wild type homozygous, 48.52% heterozygous and 6.7% mutant homozygous alleles were found in the overall population. An allelic frequency of 29.69% for the mutant allele CCR2-64I was found in HIV-exposed un-infected individuals as compared to 34.21% in HIV-infected children (p=0.47). Conclusion The CCR2-64I allele is relatively common in the Northern Region of Cameroon, with a similar distribution among HIV-exposed un-infected and infected children. As this allele alone does not seem to confer protection against HIV-1 infection, further studies using genotype-combination of CCR2 polymorphism and other single nucleotide polymorphisms would be of great relevance in both HIV prevention and novel therapeutic strategies.
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Affiliation(s)
- Marie Nicole Ngoufack
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon.,Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon
| | - Céline Nguefeu Nkenfou
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Biology, Higher Teachers' Training College, University of Yaoundé I, Yaoundé, Cameroon
| | - Barbara Atogho Tiedeu
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Linda Chapdeleine Mekue Mouafo
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Beatrice Dambaya
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Animal Sciences, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Elvis Ndukong Ndzi
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Charles Kouanfack
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Georges Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Wilfred Fon Mbacham
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Alexis Ndjolo
- Systems Biology, Chantal Biya' International Reference Centre for Research on HIV and AIDS Prevention and Management (CBIRC), Yaoundé, Cameroon
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4
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Jagodzinski LL, Manak MM, Hack HR, Liu Y, Malia JA, Freeman J, Phanuphak N, de Souza M, Kroon ED, Colby DJ, Chomchey N, Lally MA, Michael NL, Ananworanich J, Peel SA. Impact of Early Antiretroviral Therapy on Detection of Cell-Associated HIV-1 Nucleic Acid in Blood by the Roche Cobas TaqMan Test. J Clin Microbiol 2019; 57:e01922-18. [PMID: 30842229 PMCID: PMC6498003 DOI: 10.1128/jcm.01922-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/25/2019] [Indexed: 12/31/2022] Open
Abstract
The Roche Cobas AmpliPrep/Cobas TaqMan HIV-1 test, v2.0 (the CAP/CTM assay), was used to quantify cell-associated HIV-1 (CAH) nucleic acid in peripheral blood mononuclear cells (PBMC) from well-characterized clinical specimens from HIV-1-infected individuals on antiretroviral therapy (ART). Chronically infected individuals on ART with no detectable plasma HIV-1 RNA demonstrated average CAH burdens of 3.2 HIV-1 log10 copies/million cells. Assay sensitivity and specificity were 98.9% and 100%, respectively, with the positive and negative predictive values being 100% and 98.6%, respectively. The CAH burden was also measured at weeks 0, 1, 2, 8, and 60 in 37 participants (RV254/SEARCH010, Bangkok, Thailand) stratified by Fiebig stage (Fiebig stage I [FI] to FVI) at ART initiation. Prior to ART initiation, the average CAH burden was 1.4, 4.1, and 3.6 log10 copies/million PBMCs for individuals who initiated ART at FI, FII, and FIII to FVI, respectively. Initiation of ART resulted in a rapid decline of CAH in all individuals, with the greatest decrease being observed in individuals who initiated ART at FI to FIII. By week 60, 100% (FI), 71.8% (FII/FIII), and 20.5% (FIV to FVI) of samples from individuals initiating treatment were at or near the limit of quantitation. Residual CAH was detectable at 60 weeks in most individuals who initiated ART at later stages (FIV to FVI) and averaged 1.9 ± 0.7 log10 copies/million PBMCs. The modified Roche CAP/CTM assay provides a convenient, standardized approach to measure residual HIV in blood and may be useful for monitoring patients under therapy or those participating in HIV remission studies.
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Affiliation(s)
- Linda L Jagodzinski
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Mark M Manak
- U.S. Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Holly R Hack
- U.S. Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Ying Liu
- U.S. Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Jennifer A Malia
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Joanna Freeman
- U.S. Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Mark de Souza
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Eugène D Kroon
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Donn J Colby
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Nitiya Chomchey
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Michelle A Lally
- Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nelson L Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Jintanat Ananworanich
- U.S. Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Mwau M, Bwana P, Kithinji L, Ogollah F, Ochieng S, Akinyi C, Adhiambo M, Ogumbo F, Sirengo M, Boeke C. Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years. PLoS One 2017; 12:e0183860. [PMID: 28850581 PMCID: PMC5574578 DOI: 10.1371/journal.pone.0183860] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage. Design Cross-sectional analysis of national early infant diagnosis (EID) database. Methods 365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression. Results 11.1% of infants tested HIV positive in 2007–2010 and 6.9% in 2014–2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05–1.11), older children (18–24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87–4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79–2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51–3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30–1.49). In 2014–2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs. Conclusion Despite impressive gains in Kenya’s PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.
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Affiliation(s)
- Matilu Mwau
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
- * E-mail:
| | - Priska Bwana
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lucy Kithinji
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Francis Ogollah
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samuel Ochieng
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Catherine Akinyi
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Maureen Adhiambo
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Fred Ogumbo
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Martin Sirengo
- National AIDS and STIs Control Program, Ministry of Health, Nairobi, Kenya
| | - Caroline Boeke
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
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Early infant diagnosis of HIV-1 infection in Luanda, Angola, using a new DNA PCR assay and dried blood spots. PLoS One 2017; 12:e0181352. [PMID: 28715460 PMCID: PMC5513534 DOI: 10.1371/journal.pone.0181352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022] Open
Abstract
Background Early diagnosis and treatment reduces HIV-1-related mortality, morbidity and size of viral reservoirs in infants infected perinatally. Commercial molecular tests enable the early diagnosis of infection in infants but the high cost and low sensitivity with dried blood spots (DBS) limit their use in sub-Saharan Africa. Objectives To develop and validate a sensitive and cheap qualitative proviral DNA PCR-based assay for early infant diagnosis (EID) in HIV-1-exposed infants using DBS samples. Study design Chelex-based method was used to extract DNA from DBS samples followed by a nested PCR assay using primers for the HIV-1 integrase gene. Limit of detection (LoD) was determined by Probit regression using limiting dilutions of newly produced recombinant plasmids with the integrase gene of all HIV-1 subtypes and ACH-2 cells. Clinical sensitivity and specificity were evaluated on 100 HIV-1 infected adults; 5 infected infants; 50 healthy volunteers; 139 HIV-1-exposed infants of the Angolan Pediatric HIV Cohort (APEHC) with serology at 18 months of life. Results All subtypes and CRF02_AG were amplified with a LoD of 14 copies. HIV-1 infection in infants was detected at month 1 of life. Sensitivity rate in adults varied with viral load, while diagnostic specificity was 100%. The percentage of HIV-1 MTCT cases between January 2012 and October 2014 was 2.2%. The cost per test was 8-10 USD which is 2- to 4-fold lower in comparison to commercial assays. Conclusions The new PCR assay enables early and accurate EID. The simplicity and low-cost of the assay make it suitable for generalized implementation in Angola and other resource-constrained countries.
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Luo W, Davis G, Li L, Shriver MK, Mei J, Styer LM, Parker MM, Smith A, Paz-Bailey G, Ethridge S, Wesolowski L, Owen SM, Masciotra S. Evaluation of dried blood spot protocols with the Bio-Rad GS HIV Combo Ag/Ab EIA and Geenius™ HIV 1/2 Supplemental Assay. J Clin Virol 2017; 91:84-89. [PMID: 28366544 PMCID: PMC11111259 DOI: 10.1016/j.jcv.2017.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE FDA-approved antigen/antibody combo and HIV-1/2 differentiation supplemental tests do not have claims for dried blood spot (DBS) use. We compared two DBS-modified protocols, the Bio-Rad GS HIV Combo Ag/Ab (BRC) EIA and Geenius™ HIV-1/2 (Geenius) Supplemental Assay, to plasma protocols and evaluated them in the CDC/APHL HIV diagnostic algorithm. METHODS BRC-DBS p24 analytical sensitivity was calculated from serial dilutions of p24. DBS specimens included 11 HIV-1 seroconverters, 151 HIV-1-positive individuals, including 20 on antiretroviral therapy, 31 HIV-2-positive and one HIV-1/HIV-2-positive individuals. BRC-reactive specimens were tested with Geenius using the same DBS eluate. Matched plasma specimens were tested with BRC, an IgG/IgM immunoassay and Geenius. DBS and plasma results were compared using the McNemar's test. A DBS-algorithm applied to 348 DBS from high-risk individuals who participated in surveillance was compared to HIV status based on local testing algorithms. RESULTS BRC-DBS detects p24 at a concentration 18 times higher than in plasma. In seroconverters, BRC-DBS detected more infections than the IgG/IgM immunoassay in plasma (p=0.0133), but fewer infections than BRC-plasma (p=0.0133). In addition, the BRC/Geenius-plasma algorithm identified more HIV-1 infections than the BRC/Geenius-DBS algorithm (p=0.0455). The DBS protocols correctly identified HIV status for established HIV-1 infections, including those on therapy, HIV-2 infections, and surveillance specimens. CONCLUSIONS The DBS protocols exhibited promising performance and allowed rapid supplemental testing. Although the DBS algorithm missed some early infections, it showed similar results when applied to specimens from a high-risk population. Implementation of a DBS algorithm would benefit testing programs without capacity for venipuncture.
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Affiliation(s)
- Wei Luo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - LiXia Li
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joanne Mei
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda M Styer
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Amanda Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steve Ethridge
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - S Michele Owen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Performance of Roche CAP/CTM HIV-1 qualitative test version 2.0 using dried blood spots for early infant diagnosis. J Virol Methods 2015; 229:12-5. [PMID: 26706730 DOI: 10.1016/j.jviromet.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 11/21/2022]
Abstract
In the context of early infant diagnosis (EID) decentralization in sub-Saharan Africa, dried blood spot (DBS) is now widely used for HIV proviral DNA detection in resource-limited settings. A new version of CAP/CTM (version 2) has been introduced, recently by Roche Diagnosis as a new real-time PCR assay to replace previous technologies on qualitative detection of HIV-1 DNA using whole blood and DBS samples. The objective of this study was to evaluate CAP/CTM version 2 compared to CAP/CTM version 1 and Amplicor on DBS. A total of 261 DBS were collected from children aged 4 weeks to 17 months born from HIV-seropositive mothers and tested by the three techniques. CAP/CTM version 2 showed 100% of agreement with Amplicor including 74 positive results and 187 negative results. CAP/CTM version 2 versus CAP/CTM version 1 as well as CAP/CTM version 1 versus Amplicor showed two discordant results giving a sensitivity of 98.6%, specificity of 99.5%, positive predictive value of 98.6% and negative predictive value of 99.5%. The concordance was 99.12% (95% of confidence interval) giving a Kappa coefficient of 0.97 (p<0.001). These findings confirmed the expected good performance of CAP/CTM version 2 for HIV-1 EID.
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Performance of an Early Infant Diagnostic Test, AmpliSens DNA-HIV-FRT, Using Dried Blood Spots Collected from Children Born to Human Immunodeficiency Virus-Infected Mothers in Ukraine. J Clin Microbiol 2015; 53:3853-8. [PMID: 26447114 DOI: 10.1128/jcm.02392-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022] Open
Abstract
An accurate accessible test for early infant diagnosis (EID) is crucial for identifying HIV-infected infants and linking them to treatment. To improve EID services in Ukraine, dried blood spot (DBS) samples obtained from 237 HIV-exposed children (≤18 months of age) in six regions in Ukraine in 2012 to 2013 were tested with the AmpliSens DNA-HIV-FRT assay, the Roche COBAS AmpliPrep/COBAS TaqMan (CAP/CTM) HIV-1 Qual test, and the Abbott RealTime HIV-1 Qualitative assay. In comparison with the paired whole-blood results generated from AmpliSens testing at the oblast HIV reference laboratories in Ukraine, the sensitivity was 0.99 (95% confidence interval [CI], 0.95 to 1.00) for the AmpliSens and Roche CAP/CTM Qual assays and 0.96 (95% CI, 0.90 to 0.98) for the Abbott Qualitative assay. The specificity was 1.00 (95% CI, 0.97 to 1.00) for the AmpliSens and Abbott Qualitative assays and 0.99 (95% CI, 0.96 to 1.00) for the Roche CAP/CTM Qual assay. McNemar analysis indicated that the proportions of positive results for the tests were not significantly different (P > 0.05). Cohen's kappa (0.97 to 0.99) indicated almost perfect agreement among the three tests. These results indicated that the AmpliSens DBS and whole-blood tests performed equally well and were comparable to the two commercially available EID tests. More importantly, the performance characteristics of the AmpliSens DBS test meets the World Health Organization EID test requirements; implementing AmpliSens DBS testing might improve EID services in resource-limited settings.
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