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Kamble S, Gawde N, Goel N, Thorwat M, Nikhare K, Bembalkar S, Kamble S, Brahme R, Pawar S, Sahoo R, Rana M, Singh M, Mohiuddin SA, Hatnoor S, Narapureddy BR, Saleem M, Shekhawat K, Verma V, Kapoor N, Das C, Gangakhedkar R. Access, timeliness and retention for HIV testing under early infant diagnosis (EID) program, India. Sci Rep 2023; 13:5638. [PMID: 37024531 PMCID: PMC10078073 DOI: 10.1038/s41598-023-32056-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
Early Infant Diagnosis of HIV infection services are crucial for managing the perinatally acquired HIV infection. Assessing the performance of the EID services and its underlying determinants is important for the National AIDS Control Program, India. The objectives of this study were to find out access to HIV testing, the timeliness of the testing cascade, and the proportion of HIV exposed infants who are followed up to 18 months for a definitive diagnosis of HIV. The study design was a mixed method. A total of 11 states accounting for 80% of HIV-positive pregnant women were selected. Program records from a total of 62 Integrated counselling and testing centres (ICTCs) served as the source of information. The qualitative component included interviews of program managers at the state and district level, service providers at the ICTC level, and caregivers of HIV exposed infants. In the sampled 62 ICTCs, 78% of the HIV exposed infants had at least one HIV test. Of the infants who had HIV tests, 50% had at first sample collected by 8 weeks of age. The median turnaround time from sample collection to DNA PCR testing was 36 (IQR 19-70) days and that to next sample collection in case of detection of virus in the first sample was 66 (IQR 55-116) days. At 18 months of age, 544 (62%) HIV exposed infants were retained in the EID testing cascade. A total of 30 infants were diagnosed with HIV at a median age of 421 (IQR 149-650) days. More than three fourth of the HIV exposed infants had access to early infant diagnosis (EID) services. Both demand and supply-side factors contribute to access, timeliness and retention and there is a need to address these factors.
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Affiliation(s)
- Suchit Kamble
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Nilesh Gawde
- Tata Institute of Social Sciences, Mumbai, Maharashtra, India.
| | - Noopur Goel
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Mohan Thorwat
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Kalyani Nikhare
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Shilpa Bembalkar
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Sushmita Kamble
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Radhika Brahme
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Swapna Pawar
- ICMR - National AIDS Research Institute, Pune, Maharashtra, India
| | - Rakesh Sahoo
- Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Manish Rana
- GMERS Medical College, Sola, Ahmedabad, Gujarat, India
| | - Manishkumar Singh
- Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - M Saleem
- Institute of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | | | - Vinita Verma
- National AIDS Control Organisation, New Delhi, India
| | - Neha Kapoor
- National AIDS Control Organisation, New Delhi, India
| | - Chinmoyee Das
- National AIDS Control Organisation, New Delhi, India
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Mohamed Y, Htay H, Gare J, Vallely AJB, Kelly-Hanku A, Yee WL, Agius PA, Badman SG, Pham MD, Nightingale C, Chen XS, Kombati Z, Koata A, Munnull G, Silim S, Thein W, Zaw TM, Kyaw LL, Stoové M, Crowe SM, Anderson D, Tin HH, Luchters S. The effect of the Xpert HIV-1 Qual test on early infant diagnosis of HIV in Myanmar and Papua New Guinea: a pragmatic, cluster-randomised, stepped-wedge, open-label trial. Lancet HIV 2023; 10:e220-e229. [PMID: 36871568 DOI: 10.1016/s2352-3018(23)00001-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 03/06/2023]
Abstract
BACKGROUND Despite proven benefits for child health, coverage of early infant diagnosis of HIV remains suboptimal in many settings. We aimed to assess the effect of a point-of-care early infant diagnosis test on time-to-results communication for infants vertically exposed to HIV. METHODS This pragmatic, cluster-randomised, stepped-wedge, open-label trial assessed the effect of the Xpert HIV-1 Qual early infant diagnosis test (Cepheid) on time-to-results communication, compared with standard care laboratory-based testing of dried blood spots using PCR. Hospitals were the unit of randomisation for one-way crossover from control to intervention phase. Each site had between 1 month and 10 months of control phase before transitioning to the intervention, with a total of 33 hospital-months in the control phase and 45 hospital-months in the intervention phase. We enrolled infants vertically exposed to HIV at six public hospitals: four in Myanmar and two in Papua New Guinea. Infants had to have mothers with confirmed HIV infection, be younger than 28 days, and required HIV testing to be eligible for enrolment. Health-care facilities providing prevention of vertical transmission services were eligible for participation. The primary outcome was communication of early infant diagnosis results to the infant's caregiver by 3 months of age, assessed by intention to treat. This completed trial was registered with the Australian and New Zealand Clinical Trials Registry, 12616000734460. FINDINGS In Myanmar, recruitment took place between Oct 1, 2016, and June 30, 2018; in Papua New Guinea, recruitment was between Dec 1, 2016, and Aug 31, 2018. A total of 393 caregiver-infant pairs were enrolled in the study across both countries. Independent of study time, the Xpert test reduced time to early infant diagnosis results communication by 60%, compared with the standard of care (adjusted time ratio 0·40, 95% CI 0·29-0·53, p<0·0001). In the control phase, two (2%) of 102 study participants received an early infant diagnosis test result by 3 months of age compared with 214 (74%) of 291 in the intervention phase. No safety and adverse events were reported related to the diagnostic testing intervention. INTERPRETATION This study reinforces the importance of scaling up point-of-care early infant diagnosis testing in resource-constrained and low HIV-prevalence settings, typical of the UNICEF East Asia and Pacific region. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Yasmin Mohamed
- Burnet Institute, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Hla Htay
- Burnet Institute Myanmar, Yangon, Myanmar
| | - Janet Gare
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Andrew J B Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Paul A Agius
- Burnet Institute, Melbourne, VIC, Australia; Faculty of Health, Deakin University, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Steven G Badman
- Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Minh Duc Pham
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Claire Nightingale
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Xiang-Sheng Chen
- Chinese Academy of Medical Science, Institute of Dermatology and National Centre for STD Control, Nanjing, China
| | - Zure Kombati
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Mount Hagen General Hospital, Mount Hagen, Western Highlands Province, Papua New Guinea
| | - Amelia Koata
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Gloria Munnull
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Mount Hagen General Hospital, Mount Hagen, Western Highlands Province, Papua New Guinea
| | - Selina Silim
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Win Thein
- National Health Laboratory, Yangon, Myanmar
| | - Tin Maung Zaw
- National AIDS Program (Yangon Region), Ministry of Health and Sports, Yangon, Myanmar
| | | | | | | | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe; Liverpool School of Tropical Medicine, Liverpool, UK; International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Yee WL, Htay H, Mohamed Y, Nightingale CE, Tin HH, Thein W, Kyaw LL, Yee WW, Aye MM, Badman SG, Vallely AJ, Anderson D, Kelly-Hanku A, Luchters S. Operational experiences associated with the implementation of near point-of-care early infant diagnosis of HIV in Myanmar: a qualitative study. BMC Health Serv Res 2021; 21:863. [PMID: 34425814 PMCID: PMC8383426 DOI: 10.1186/s12913-021-06797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Timely diagnosis and early initiation of life-saving antiretroviral therapy are critical factors in preventing mortality among HIV-infected infants. However, resource-limited settings experience numerous challenges associated with centralised laboratory-based testing, including low rates of testing, complex sample referral pathways and unacceptably long turnaround times for results. Point-of-care (POC) HIV testing for HIV-exposed infants can enable same-day communication of results and early treatment initiation for HIV-infected infants. However, complex operational issues and service integration can limit utility and must be well understood prior to implementation. We explored and documented the challenges and enabling factors in implementing the POC Xpert® HIV-1 Qual test (Cepheid, Sunnyvale, CA, USA) for early infant diagnosis (EID) as part of routine services in four public hospitals in Myanmar. Methods This sub-study was part of a randomised controlled stepped-wedge trial (Australian and New Zealand Clinical Trials Registry, number 12616000734460) designed to investigate the impact of POC testing for EID in Myanmar and Papua New Guinea. Infants recruited during the intervention phase underwent POC testing at the participating hospitals as part of routine care. Semi-structured interviews with 23 caregivers, 12 healthcare providers and 10 key informants were used to explore experiences of POC-EID testing. The research team and hospital staff documented and discussed implementation challenges throughout the study. Results Overall, caregivers and healthcare workers were satisfied with the short turnaround time of the POC test. Occasional delays in POC testing were mostly attributable to late receipt of samples by laboratory technicians and communication constraints among healthcare staff. Hospital staff valued technical assistance from the research group and the National Health Laboratory. Despite staff shortages and infrastructure challenges such as unreliable electricity supply and cramped space, healthcare workers and caregivers found the implementation of the POC test to be feasible at pilot sites. Conclusions As plans for national scale-up evolve, there needs to be a continual focus on staff training, communication pathways and infrastructure. Other models of care, such as allowing non-laboratory-trained personnel to perform POC testing, and cost effectiveness should also be evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06797-3.
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Affiliation(s)
| | - Hla Htay
- Burnet Institute, Yangon, Myanmar
| | - Yasmin Mohamed
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Claire E Nightingale
- Burnet Institute, Melbourne, Australia.,Monash Rural Health, Monash University, Bendigo, Australia
| | | | - Win Thein
- National Health Laboratory, Yangon, Myanmar
| | | | | | | | - Steven G Badman
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
| | - Andrew J Vallely
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
| | | | - Angela Kelly-Hanku
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia.,Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stanley Luchters
- Burnet Institute, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya. .,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
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Kalawan V, Naidoo K, Archary M. Impact of routine birth early infant diagnosis on neonatal HIV treatment cascade in eThekwini district, South Africa. South Afr J HIV Med 2020; 21:1084. [PMID: 32537251 PMCID: PMC7276481 DOI: 10.4102/sajhivmed.v21i1.1084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Early infant diagnosis (EID) of human immunodeficiency virus (HIV) and early initiation of antiretroviral therapy (ART) in HIV-infected infants can reduce the risk of mortality and improve clinical outcomes. Infant testing guidelines in KwaZulu-Natal, South Africa, changed from targeted birth EID (T-EID) only in high-risk infants to a routine birth EID (R-EID) testing strategy in 2015. Objectives To describe the impact of the implementation of R-EID on the infant treatment cascade. Method A retrospective analysis of a facility-based clinical database for the eThekwini district and the National Health Laboratory Services (NHLS) was conducted. All data on neonates (< 4 weeks of age) diagnosed with HIV between January 2013 and December 2017 (T-EID [2013-2015] and R-EID [2016-2017]) were extracted including follow-up until 1 year post-diagnosis. Results A total of 503 neonates were diagnosed HIV-infected, with 468 (93.0%) initiated on ART within a median of 6 days. There was a significant increase in the estimated percentage of HIV-infected neonates diagnosed (21% vs. 86%, p < 0.001) and initiated on ART (90% vs. 94.3%, p < 0.001) between the T-EID and R-EID periods. Despite achieving over 90% of HIV-infected neonates diagnosed and initiated on ART in 2017, retention in care and viral suppression remained low. Conclusion Implementation of R-EID in eThekwini district improved diagnosis and initiation of ART in HIV-infected neonates and should be recommended as part of diagnostic guidelines. These gains are, however, lost because of poor retention in care and viral suppression rates and therefore required urgent attention.
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Affiliation(s)
- Vidya Kalawan
- Department of Paediatrics and Children Health, University of KwaZulu-Natal, Durban, South Africa.,King Dinizulu Hospital, Durban, South Africa
| | - Kevindra Naidoo
- Maternal Adolescent and Child Health (MatCH), University of the Witwatersrand, Johannesburg, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Children Health, University of KwaZulu-Natal, Durban, South Africa.,King Edward VIII Hospital, Durban, South Africa
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Malekjahani A, Sindhwani S, Syed AM, Chan WCW. Engineering Steps for Mobile Point-of-Care Diagnostic Devices. Acc Chem Res 2019; 52:2406-2414. [PMID: 31430118 DOI: 10.1021/acs.accounts.9b00200] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mobile phone technology is a perfect companion for point-of-care diagnostics as they come equipped with advanced processors, high resolution cameras, and network connectivity. Despite several academic pursuits, only a few mobile phone diagnostics have been tested in the field, commercialized or achieved regulatory approval. This review will address the challenges associated with developing mobile diagnostics and suggest strategies to overcome them. We aim to provide a resource for researchers to accelerate the development of new diagnostics. Our Account includes an overview of published mobile phone diagnostics and highlights lessons learned from their approach to diagnostic development. Also, we have included recommendations from regulatory and public health agencies, such as the U.S. Food and Drug Administration and World Health Organization, to further guide researchers. We believe that the development of mobile phone point-of-care diagnostics takes place in four distinct steps: (1) Needs and Value Assessment, (2) Technology Development, (3) Preclinical Verification, and (4) Clinical Validation and Field Trials. During each step, we outline developmental strategies to help researchers avoid potential challenges. (1) Researchers commonly develop devices to maximize technical parameters such as sensitivity and time which do not necessarily translate to increased clinical impact. Researchers must focus on assessing specific diagnostic needs and the value which a potential device would offer. (2) Often, researchers claim they have developed devices for feasible implementation at the point-of-care, yet they rely on laboratory resources. Researchers must develop equipment-free devices which are agnostic to any mobile phone. (3) Another challenge researchers face is decreased performance during field evaluations relative to initial laboratory verification. Researchers must ensure that they simulate the field conditions during laboratory verification to achieve successful translation. (4) Finally, proper field testing of devices must be performed in conditions which match that of the final intended use. The future of mobile phone point-of-care diagnostic devices is bright and has the potential to radically change how patients are diagnosed. Before we reach this point, researchers must take a step backward and focus on the first-principles of basic research. The widespread adoption and rapid scaling of these devices can only be achieved once the fundamentals have been considered. The insights and strategies provided here will help researchers avoid pitfalls, streamline development and make better decisions during the development of new diagnostics. Further, we believe this Account can help push the field of mobile diagnostics toward increased productivity, leading to more approved devices and ultimately helping curb the burden of disease worldwide.
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Affiliation(s)
- Ayden Malekjahani
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
| | - Shrey Sindhwani
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
| | - Abdullah Muhammad Syed
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
| | - Warren C. W. Chan
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
- Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON M5S 3E5, Canada
- Department of Chemistry, University of Toronto, 80 St. George, Toronto, ON M5S 3H6, Canada
- Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON M5S 1A4, Canada
- Donnelly Center for Cellular and Biomolecular Research, University of Toronto, 160 College St, Toronto, ON M5S 3E1, Canada
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Agutu CA, Ngetsa CJ, Price MA, Rinke de Wit TF, Omosa-Manyonyi G, Sanders EJ, Graham SM. Systematic review of the performance and clinical utility of point of care HIV-1 RNA testing for diagnosis and care. PLoS One 2019; 14:e0218369. [PMID: 31246963 PMCID: PMC6597060 DOI: 10.1371/journal.pone.0218369] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/31/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Point of-care (POC) HIV-1 RNA tests which are accurate and easy to use with limited infrastructure are needed in resource-limited settings (RLS). We systematically reviewed evidence of POC test performance compared to laboratory-based HIV-1 RNA assays and the potential utility of these tests for diagnosis and care in RLS. METHODS Studies published up to July 2018 were identified by a search of PUBMED, EMBASE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials. Studies evaluating the use of POC HIV-1 RNA testing for early infant diagnosis (EID), acute HIV infection (AHI) diagnosis, or viral load monitoring (VL), compared to centralized testing, were included. Separate search strategies were used for each testing objective. RESULTS 197 abstracts were screened and 34 full-text articles were assessed, of which 32 met inclusion criteria. Thirty studies evaluated performance and diagnostic accuracy of POC tests compared to standard reference tests. Two of the thirty and two additional studies with no comparative testing reported on clinical utility of POC results. Five different POC tests (Cepheid GeneXpert HIV-1 Quantitative and Qualitative assays, Alere q HIV-1/2 Detect, SAMBA, Liat HIV Quant and Aptima HIV-1 Quant) were used in 21 studies of VL, 11 of EID and 2 of AHI. POC tests were easy to use, had rapid turnaround times, and comparable accuracy and precision to reference technologies. Sensitivity and specificity were high for EID and AHI but lower for VL. For VL, lower sensitivity was reported for whole blood and dried blood spots compared to plasma samples. Reported error rates for Cepheid GeneXpert Qual (2.0%-5.0%), GeneXpert Quant (2.5%-17.0%) and Alere q HIV-1/2 Detect (3.1%-11.0%) were higher than in WHO prequalification reports. Most errors resolved with retesting; however, inadequate sample volumes often precluded repeat testing. Only two studies used POC results for clinical management, one for EID and another for VL. POC EID resulted in shorter time-to-result, rapid ART initiation, and better retention in care compared to centralised testing. CONCLUSIONS Performance of POC HIV-1 RNA tests is comparable to reference assays, and have potential to improve patient outcomes. Additional studies on implementation in limited-resources settings are needed.
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Affiliation(s)
- Clara A. Agutu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Caroline J. Ngetsa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Matt A. Price
- International AIDS Vaccine Initiative (IAVI), Department of Medical Affairs, New York, New York, United States of America
| | - Tobias F. Rinke de Wit
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Gloria Omosa-Manyonyi
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Eduard J. Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Susan M. Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
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Wexler C, Kamau Y, Halder R, Brown M, Maloba M, Mabachi N, Sandbulte M, Gautney B, Goggin K, Odeny T, Finocchario-Kessler S. "Closing the Gap": Provider Recommendations for Implementing Birth Point of Care HIV Testing. AIDS Behav 2019; 23:1073-1083. [PMID: 30542834 DOI: 10.1007/s10461-018-2363-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Delays in traditional HIV DNA PCR testing for early infant diagnosis (EID) at 6 weeks of age result in late antiretroviral treatment (ART). Birth point of care (POC) testing is an emerging strategy with the potential to streamline EID services. We elicited providers' recommendations for introducing birth POC testing to guide strategies in Kenya and similar settings. We conducted formative interviews with 26 EID providers from four Kenyan hospitals prior to POC implementation. Providers discussed the need for comprehensive training, covering both EID and POC-specific topics for all key personnel. Providers highlighted equipment considerations, such as protocols for maintenance and safe storage. Providers emphasized the need for maternal counseling to ensure patient acceptance and most agreed that specimen collection for birth POC testing should occur in the maternity department and supported a multidisciplinary approach. Though most providers supported ART initiation based on a positive birth POC result, a few expressed concerns with result validity. To maximize implementation success, provider training, equipment security, maternal counseling, and logistics of testing must be planned and communicated to providers.
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8
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Abuogi LL, Humphrey JM, Mpody C, Yotebieng M, Murnane PM, Clouse K, Otieno L, Cohen CR, Wools-Kaloustian K. Achieving UNAIDS 90-90-90 targets for pregnant and postpartum women in sub-Saharan Africa: progress, gaps and research needs. J Virus Erad 2018; 4:33-39. [PMID: 30515312 PMCID: PMC6248851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The implementation of the 2013 World Health Organization Option B+ recommendations for HIV treatment during pregnancy has helped drive significant progress in achieving universal treatment for pregnant and postpartum women in sub-Saharan Africa (SSA). Yet, critical research and implementation gaps exist in achieving the UNAIDS 90-90-90 targets. To help guide researchers, programmers and policymakers in prioritising these areas, we undertook a comprehensive review of the progress, gaps and research needs to achieve the 90-90-90 targets for this population in the Option B+ era, including early infant HIV diagnosis (EID) for HIV-exposed infants. Salient areas where progress has been achieved or where gaps remain include: (1) knowledge of HIV status is higher among people with HIV in southern and eastern Africa compared to western and central Africa (81% versus 48%, UNAIDS); (2) access to antiretroviral therapy (ART) for pregnant women has doubled in 22 of 42 SSA countries, but only six have achieved the second 90, and nearly a quarter of pregnant women initiating ART become lost to follow-up; (3) viral suppression data for this population are sparse (estimates range from 30% to 98% peripartum), with only half of women maintaining suppression through 12 months postpartum; and (4) EID rates range from 15% to 62%, with only three of 21 high-burden SSA countries testing >50% HIV-exposed infants within the first 2 months of life. We have identified and outlined promising innovations and research designed to address these gaps and improve the health of pregnant and postpartum women living with HIV and their infants.
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Affiliation(s)
- Lisa L Abuogi
- Department of Pediatrics, University of Colorado,
Denver, Aurora, CO,
USA,Corresponding author:
Lisa Abuogi, Department of Pediatrics, University of Colorado,
Denver, Aurora,
CO,
USA
| | - John M Humphrey
- Department of Medicine, Indiana University School of Medicine,
Indianapolis, IN,
USA
| | - Christian Mpody
- Division of Epidemiology, Ohio State University,
Columbus, OH,
USA
| | - Marcel Yotebieng
- Division of Epidemiology, Ohio State University,
Columbus, OH,
USA
| | - Pamela M Murnane
- Center for AIDS Prevention Studies, University of California San Francisco,
San Francisco, CA,
USA
| | - Kate Clouse
- Vanderbilt Institute for Global Health, Vanderbilt University,
Nashville, TN,
USA
| | - Lindah Otieno
- Center for Microbial Research, Research Care and Training Program, Kenya Medical Research Institute,
Nairobi,
Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences,
University of California San Francisco, CA,
USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine,
Indianapolis, IN,
USA
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Achieving UNAIDS 90-90-90 targets for pregnant and postpartum women in sub-Saharan Africa: progress, gaps and research needs. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30343-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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10
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Peter T, Zeh C, Katz Z, Elbireer A, Alemayehu B, Vojnov L, Costa A, Doi N, Jani I. Scaling up HIV viral load - lessons from the large-scale implementation of HIV early infant diagnosis and CD4 testing. J Int AIDS Soc 2018; 20 Suppl 7. [PMID: 29130601 PMCID: PMC5978645 DOI: 10.1002/jia2.25008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The scale-up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point-of-care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low-resource countries. The purpose of this commentary is to review the challenges and solutions from the large-scale implementation of other diagnostic tests, namely nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale-up of VL. DISCUSSION Experience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale-up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow-up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business. CONCLUSIONS The lessons and innovations from large-scale EID and CD4 programs described here can be adapted to inform more effective scale-up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost-effective test access.
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Affiliation(s)
- Trevor Peter
- Clinton Health Access Initiative, Gaborone, Botswana
| | - Clement Zeh
- United States Centers for Disease Control, Addis Ababa, Ethiopia
| | - Zachary Katz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Ali Elbireer
- African Society for Laboratory Medicine, Addid Ababa, Ethiopia
| | | | - Lara Vojnov
- World Health Organization, Geneva, Switzerland
| | | | - Naoko Doi
- Clinton Health Access Initiative, Gaborone, Botswana
| | - Ilesh Jani
- Institut Nacional Da Saude, Maputo, Mozambique
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Katoba J, Hangulu L, Mashamba-Thompson TP. Evidence of accessibility and utility of point-of-care diagnostics as an integral part of prevention of mother-to-child transmission services: systematic scoping review protocol. BMJ Open 2017; 7:e017884. [PMID: 29102993 PMCID: PMC5695340 DOI: 10.1136/bmjopen-2017-017884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/17/2017] [Accepted: 09/08/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Point-of-care (POC) testing has been shown to help improve healthcare access in resource-limited settings. However, there is paucity of evidence on accessibility of POC testing for prevention of mother-to-child transmission (PMTCT) in resource-limited settings. We propose to conduct a systematic scoping review to map the evidence on POC testing services for PMTCT. METHODS AND ANALYSIS A scoping review framework, proposed by Arksey and O'Malley, will guide the study. A comprehensive literature search will be performed in the following electronic databases: PubMed, Science Direct, Cochrane Central, Google Scholar and databases within EBSCOhost (Medline and CINAHL). The primary research articles published in peer-reviewed journals and grey articles addressing our question will be included. One reviewer will conduct title screening and the results will be exported to endnote library. Two independent reviewers will perform abstract, then full article screening in parallel. The same process shall be employed to extract data from eligible studies. Data analysis will involve a narrative summary of included studies and thematic content analysis aided by NVIVO software V.11. The mixed methods assessment tool will be used to assess the quality of studies that will be included. ETHICS AND DISSEMINATION Ethical approval is not applicable to this study. The study findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences related to syphilis, HIV, PMTCT, bacterial infections and POC diagnostics. TRIAL REGISTRATION NUMBER CRD42017056267.
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Affiliation(s)
- Juliet Katoba
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lydia Hangulu
- Discipline of Psychology, School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Durban, South Africa
| | - Tivani Phosa Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Field Evaluation of Performance of Alere and Cepheid Qualitative HIV Assays for Pediatric Point-of-Care Testing in an Academic Hospital in Soweto, South Africa. J Clin Microbiol 2017; 55:3227-3235. [PMID: 28855305 DOI: 10.1128/jcm.01021-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/20/2017] [Indexed: 12/30/2022] Open
Abstract
Point-of-care (POC) technologies for HIV diagnosis in infants have the potential to overcome logistical challenges that delay treatment initiation and prevent improvements in morbidity and mortality. This study aimed to evaluate the performance of two POC technologies against the current standard-of-care (SOC) laboratory-based assay in South Africa, when operated by nurses in a hospital environment. Children <18 months of age who were treatment naive (excluding prophylaxis) and in whom an HIV PCR test was indicated were eligible for the study. To increase the rate of enrollment of HIV PCR-positive children, HIV-exposed neonates at high risk of mother-to-child transmission and children requiring confirmatory HIV testing were preferentially enrolled. The two POC technologies demonstrated excellent concordance, with 315 (97.8%) results consistent with the SOC result. The POC technologies yielded 102 positive and 220 negative tests each. The SOC assay had 101 positive, 214 negative, 4 indeterminate, 1 invalid, and 2 specimen-rejected results. To include the indeterminate results in sensitivity/specificity calculations, a sensitivity analysis was performed, which yielded a simulated sensitivity of 0.9904 (interquartile range [IQR], 0.9808 to 0.9904) and a specificity of 0.9954 (IQR, 0.9954 to 1.0). This study confirmed that both POC technologies can be successfully used outside the laboratory environment to yield precise sensitivity/specificity values for pediatric, including neonatal, HIV testing.
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Hampanda KM, Nimz AM, Abuogi LL. Barriers to uptake of early infant HIV testing in Zambia: the role of intimate partner violence and HIV status disclosure within couples. AIDS Res Ther 2017; 14:17. [PMID: 28320431 PMCID: PMC5360055 DOI: 10.1186/s12981-017-0142-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early detection of pediatric HIV through uptake of infant HIV testing is critical for access to treatment and child survival. While structural barriers have been well described, a greater understanding of social and behavioral factors that may relate to maternal uptake of early infant HIV testing services is urgently needed. The aim of this study was to explore how gender power dynamics within couples affect HIV-positive women's uptake of early infant HIV testing at a large health center in Lusaka, Zambia. METHODS In 2014, 320 HIV-positive married postpartum women were recruited at a large public health facility in Lusaka to participate in a cross-sectional survey. Data on uptake of early infant HIV testing by 4-6 weeks of age was collected through medical records. Simple and multiple logistic regression models determined significant predictors of maternal uptake of early infant HIV testing. RESULTS In the adjusted model, uptake of early infant HIV testing was associated with female-directed emotional intimate partner violence (aOR 0.41; 95% CI 0.21-0.79; p < 0.01), HIV status disclosure to the male partner (aOR 13.73, 95% CI 3.59-52.49, p < 0.001), and maternal postpartum ART adherence (aOR 2.28, 95% CI 1.15-4.55, p < 0.05). CONCLUSIONS Domestic relationship dynamics, including emotional violence and HIV status disclosure to the male partner, may play an important role in maternal uptake of early infant HIV testing. These findings provide additional evidence for the link between intimate partner violence against women and poor HIV-related health outcomes. Programs that adequately screen for and address various forms of intimate partner violence within the context of prevention of mother-to-child transmission are recommended.
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