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Boniface S, Lwilla A, Mahiga H, Pamba D, Geisenberger O, France J, Mokeha R, Njovu L, Kisinda A, Ntinginya NE, Hoelscher M, Kroidl A, Sabi I. Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study. AIDS Res Ther 2024; 21:33. [PMID: 38755626 PMCID: PMC11097447 DOI: 10.1186/s12981-024-00619-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/23/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND HIV early infant diagnosis (HEID) at the centralized laboratory faces many challenges that impact the cascade of timely HEID. Point of Care (PoC) HEID has shown to reduce test turnaround times, allow for task shifting and has the potential to reduce infant mortality. We aimed at assessing the feasibility of nurse based PoC-HEID in five facilities of Mbeya region. METHODS We analysed data from healthcare workers at five obstetric health facilities that participated in the BABY study which enrolled mothers living with HIV and their HIV exposed infants who were followed up until 6 weeks post-delivery. Nurses and laboratory personnel were trained and performed HEID procedures using the Xpert HIV-1 Qual PoC systems. Involved personnel were interviewed on feasibility, knowledge and competency of procedures and overall impression of the use of HIV-1 Qual PoC system in clinical settings. RESULTS A total of 28 health care workers (HCWs) who participated in the study between 2014 and 2016 were interviewed, 23 being nurses, 1 clinical officer, 1 lab scientist and 3 lab technicians The median age was 39.5 years. Majority of the nurses (22/24) and all lab staff were confident using Gene Xpert PoC test after being trained. None of them rated Gene Xpert handling as too complicated despite minor challenges. Five HCWs (5/24) reported power cut as the most often occurring problem. As an overall impression, all interviewees agreed on PoC HEID to be used in clinical settings however, about half of them (11/24) indicated that the PoC-HEID procedures add a burden onto their routine workload. CONCLUSION Overall, health care workers in our study demonstrated very good perceptions and experiences of using PoC HEID. Efforts should be invested on quality training, targeted task distribution at the clinics, continual supportive supervision and power back up mechanisms to make the wide-scale adoption of nurse based PoC HEID testing a possibility.
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Affiliation(s)
- Siriel Boniface
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania
| | - Anange Lwilla
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania.
| | - Hellen Mahiga
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania
| | - Doreen Pamba
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Otto Geisenberger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - John France
- Department of Obstetrics and Gynaecology, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Rebecca Mokeha
- Department of Obstetrics and Gynaecology, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Lilian Njovu
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania
| | - Abisai Kisinda
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania
| | - Nyanda Elias Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania
| | | | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
- CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Issa Sabi
- National Institute for Medical Research, Mbeya Medical Research Center, P.O.Box 2410, Mbeya, Tanzania
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Adella FJ, Vanna M, Adhikari B, Ol S, Tripura R, Davoeung C, Callery JJ, Sovann Y, Chandna A, Bunreth V, Asnong C, von Seidlein L, Dondorp AM, Maude RJ, Lubell Y, Wills B, Lek D, Peto TJ. The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study. Trans R Soc Trop Med Hyg 2023; 117:788-796. [PMID: 37317948 PMCID: PMC10629948 DOI: 10.1093/trstmh/trad036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. The objective of this study was to assess the feasibility of point-of-care tests to diagnose acute febrile illnesses in primary care settings. METHODS A mixed-methods study was conducted at nine rural health centres in western Cambodia. Workshops introduced health workers to the STANDARD(TM) Q Dengue Duo, STANDARD(TM) Q Malaria/CRP Duo and a multiplex biosensor detecting antibodies and/or antigens of eight pathogens. Sixteen structured observation checklists assessed users' performances and nine focus group discussions explored their opinions. RESULTS All three point-of-care tests were performed well under assessment, but sample collection was difficult for the dengue test. Respondents expressed that the diagnostics were useful and could be integrated into routine clinical care, but were not as convenient to perform as standard malaria rapid tests. Health workers recommended that the most valued point-of-care tests would directly inform clinical management (e.g. a decision to refer a patient or to provide/withhold antibiotics). CONCLUSIONS Deployment of new point-of-care tests to health centres could be feasible and acceptable if they are user-friendly, selected for locally circulating pathogens and are accompanied by disease-specific education and simple management algorithms.
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Affiliation(s)
- Fidelis Jacklyn Adella
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Moul Vanna
- Action for Health Development, Battambang 021404, Cambodia
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Sam Ol
- Action for Health Development, Battambang 021404, Cambodia
| | - Rupam Tripura
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Chan Davoeung
- Battambang Provincial Health Department, Battambang, Cambodia
| | - James J Callery
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Yok Sovann
- Pailin Provincial Health Department, Pailin, Cambodia
| | - Arjun Chandna
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap 171202, Cambodia
| | | | - Carina Asnong
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Lorenz von Seidlein
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Richard J Maude
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- The Open University, Milton Keynes, MK7 6AA, UK
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Bridget Wills
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | - Dysoley Lek
- School of Public Health, National Institute of Public Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
- National Centre for Parasitology, Entomology and Malaria Control, 477 Betong, Khan Sen Sok, Phnom Penh, Cambodia
| | - Thomas J Peto
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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le Roux SM, Odayar J, Sutcliffe CG, Salvatore PP, de Broucker G, Dowdy D, McCann NC, Frank SC, Ciaranello AL, Myer L, Vojnov L. Cost-effectiveness of point-of-care versus centralised, laboratory-based nucleic acid testing for diagnosis of HIV in infants: a systematic review of modelling studies. Lancet HIV 2023; 10:e320-e331. [PMID: 37149292 PMCID: PMC10175481 DOI: 10.1016/s2352-3018(23)00029-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Point-of-care (POC) nucleic acid testing for diagnosis of HIV in infants facilitates earlier initiation of antiretroviral therapy (ART) than with centralised (standard-of-care, SOC) testing, but can be more expensive. We evaluated cost-effectiveness data from mathematical models comparing POC with SOC to provide global policy guidance. METHODS In this systematic review of modelling studies, we searched PubMed, MEDLINE, Embase, the National Health Service Economic Evaluation Database, Econlit, and conference abstracts, combining terms for "HIV" + "infant"/"early infant diagnosis" + "point-of-care" + "cost-effectiveness" + "mathematical models", without restrictions from database inception to July 15, 2022. We selected reports of mathematical cost-effectiveness models comparing POC with SOC for HIV diagnosis in infants younger than 18 months. Titles and abstracts were independently reviewed, with full-text review for qualifying articles. We extracted data on health and economic outcomes and incremental cost-effectiveness ratios (ICERs) for narrative synthesis. The primary outcomes of interest were ICERs (comparing POC with SOC) for ART initiation and survival of children living with HIV. FINDINGS Our search identified 75 records through database search. 13 duplicates were excluded, leaving 62 non-duplicate articles. 57 records were excluded and five were reviewed in full text. One article was excluded as it was not a modelling study, and four qualifying studies were included in the review. These four reports were from two mathematical models from two independent modelling groups. Two reports used the Johns Hopkins model to compare POC with SOC for repeat early infant diagnosis testing in the first 6 months in sub-Saharan Africa (first report, simulation of 25 000 children) and Zambia (second report, simulation of 7500 children). In the base scenario, POC versus SOC increased probability of ART initiation within 60 days of testing from 19% to 82% (ICER per additional ART initiation range US$430-1097; 9-month cost horizon) in the first report; and from 28% to 81% in the second ($23-1609, 5-year cost horizon). Two reports compared POC with SOC for testing at 6 weeks in Zimbabwe using the Cost-Effectiveness of Preventing AIDS Complications-Paediatric model (simulation of 30 million children; lifetime horizon). POC increased life expectancy and was considered cost-effective compared with SOC (ICER $711-850 per year of life saved in HIV-exposed children). Results were robust throughout sensitivity and scenario analyses. In most scenarios, platform cost-sharing (co-use with other programmes) resulted in POC being cost-saving compared with SOC. INTERPRETATION Four reports from two different models suggest that POC is a cost-effective and potentially cost-saving strategy for upscaling of early infant testing compared with SOC. FUNDING Bill & Melinda Gates Foundation, Unitaid, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, WHO, and Massachusetts General Hospital Research Scholars.
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Affiliation(s)
- Stanzi M le Roux
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
| | - Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Catherine G Sutcliffe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Phillip P Salvatore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gatien de Broucker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicole C McCann
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital Boston, MA, USA
| | - Simone C Frank
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital Boston, MA, USA
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital Boston, MA, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Lara Vojnov
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
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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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Ansu-Mensah M, Kuupiel D, Asiamah EA, Ginindza TG. Facilitators and barriers to in vitro diagnostics implementation in resource-limited settings: A scoping review. Afr J Prim Health Care Fam Med 2023; 15:e1-e9. [PMID: 36861922 PMCID: PMC9982514 DOI: 10.4102/phcfm.v15i1.3777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) developed the model list of essential in vitro diagnostics (EDL) to guide countries to develop and update point-of-care (POC) per their disease priorities. The EDL includes POC diagnostic tests for use in health facilities without laboratories; however, their implementation might face several challenges in low- and middle-income countries (LMICs). AIM To identify facilitators and barriers to POC testing service implementations in the primary health care facilities in the LMICs. SETTING Low- and middle-income countries. METHODS This scoping review was guided by Arksey and O'Malley's methodological framework. A comprehensive keyword search for literature was conducted in Google Scholar, EBSCOhost, PubMed, Web of Science and ScienceDirect using the Boolean terms ('AND' and 'OR'), as well as Medical Subject Headings. The study considered published articles in the English language from 2016 to 2021 and was limited to qualitative, quantitative and mixed-method studies. Two reviewers independently screened the articles at the abstract and full-text screening phases guided by the eligibility criteria. Data were analysed qualitatively and quantitatively. RESULTS Of the 57 studies identified through literature searches, 16 met this study's eligibility criteria. Of the 16 studies, 7 reported on both facilitators and barriers; and the remainder reported on only barriers to POC test implementation such as inadequate funding, insufficient human resource, stigmatisation, et cetera. CONCLUSION The study demonstrated a wide research gap in facilitators and barriers, especially in the general POC diagnostic test for use in health facilities without laboratories in the LMICs. Extensive research in POC testing service is recommended to improve service delivery.Contribution: This study's findings contribute to a few works of literature on existing evidence of POC testing.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and The University Clinic, Sunyani Technical University, Sunyani.
| | - Desmond Kuupiel
- Department of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Emmanuel A. Asiamah
- Department of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Centre for Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Themba G. Ginindza
- Department of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Centre for Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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da Silva Calvo K, Knauth DR, Hentges B, Leal AF, da Silva MA, Silva DL, Vasques SC, Hamester L, da Silva DAR, Dorneles FV, Fraga FS, Bobek PR, Teixeira LB. Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil. BMC Public Health 2022; 22:1422. [PMID: 35883036 PMCID: PMC9327199 DOI: 10.1186/s12889-022-13791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. METHODS This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. RESULTS Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother's self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). CONCLUSION Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.
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Affiliation(s)
- Karen da Silva Calvo
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Daniela Riva Knauth
- Department of Social Medicine, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Bruna Hentges
- Department of Social Medicine, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Andrea Fachel Leal
- Graduate Studies Program in Public Policy, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Mariana Alberto da Silva
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Danielle Lodi Silva
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Samantha Correa Vasques
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Letícia Hamester
- Professional Master's in Family Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | | | | | | | - Paulo Ricardo Bobek
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil
| | - Luciana Barcellos Teixeira
- Graduate Studies Program in Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, 90620-110, Brazil.
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil.
- Department of Public Health, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil.
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