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Towards getting more HIV-positive infants on lifesaving treatment: assessing turn-around times for early infant diagnosis in LesothoM Gill, HJ Hoffman, A Isavwa, M Mokone, M Foso, JT Safrit, A Tiam MOAD0202
Kingdom of Lesotho
Population 1.9 million
HIV prevalence among pregnant women
27.7%
ANC attendance (first visit) 91.8%
Deliveries in health facilities 69.8%
HIV testing in ANC 95%
Maternal PMTCT coverage (facility based)
96%
Infant prophylaxis uptake(facility based)
97%
DHS-MOH , 2009; Annual joint review MOH, 2013.
Background
Globally, only 34% of ART eligible children aged <15 years are receiving ART
Without treatment, 1/3 of HIV-infected children will not see their first birthday and almost 1/2 will die before 2 years of age
In Lesotho 37,000 children are living with HIV 38% of eligible children are receiving ART Average ART initiation is 5 years of age
Long turn-around-time (TAT) for early infant diagnosis (EID) has been identified as a significant challenge
DK. Ekouevi et all 2011 ; WHO/UAIDS/UNICEF Universal Access 2011; S. Essajee, 2010; UNAIDS, 2013
Objectives
1) To identify delays in the EID process, from sample collection to receipt of results by caregiver and infant ART initiation in HIV infected infants
2) To determine the 6-8 week HIV infection rate among HIV exposed infants who had an EID test done
Methods
Retrospective review of all 6-8 week-old, HIV-exposed infants who received an HIV test in selected sites in 2011; central lab records linked to facility records
25 purposefully selected study sites: Included sites from both hospitals and health centers
and each of the three geographic zones Included 11 hard-to-reach sites with higher-than-
average EID turnaround time
TAT for EID was calculated using abstracted dates from laboratory EID database and registers
Geometric means (with 95% CI) for TAT were calculated and compared by region using linear mixed models
Step-by-step DNA-PCR testing in Lesotho
Infant/mother characteristics
HIV-exposed infants with 6-8 week EID (n=1187)
Mean age at blood draw (days) 47
HIV-positive children (n) 47
HIV transmission rate at 6-8 weeks 4%
HIV infected mothers of study infants (n=1045)
Mean maternal age (years) 28
Mean gravida/parity 2.4/1.4
Mean number of ANC visits 3.1
Mean gestational age at first ANC (weeks)
26
EID Total TAT time: 61.7 days (CI = 55.3, 68.7)
14.0 days
2.7 days
23.3 days
3.3 days
10.4 days
Mean TAT per stage by Geography
Result to caregiver- infant ART
Health Facility -result to caregiver
District lab -result to health facility
Central lab -result to district lab
District lab -central lab
Specimen-district lab
0 5 10 15 20 25 30 35 40
Number of Days
Highlands LowlandsFoothills
Mean TAT per stage by HIV status
Result to caregiver- infant ART
Health Facility -result to caregiver
District lab -result to health facility
Central lab -result to district lab
District lab -central lab
Specimen-district lab
0 5 10 15 20 25
Number of Days
HIV uninfected HIV infected
Mean TAT from HIV positive results to initiation on ART distributed by region
Lowlands Foothills Highlands Mean0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Time to ART
Time to ART
Num
ber o
f day
s
Results return for HIV infected infants
• HIV positive EID results are distributed by EGPAF through mobile 3-G internet to health facilities ahead of paper based results.
• Once Health care workers are informed,
community workers track the infant before the appointment date.
Conclusions
• Average TAT from specimen collection to caregiver receipt of test results in the study facilities was approximately 2 months.
• The longest delay occurred between specimen receipt in the central laboratory and result receipt at the district laboratory
• HIV infected infants had rapid ART initiation due to a system of expedited notification of positive results to caregivers and same-day treatment initiation
• Interventions to expedite result transfer back to facilities and in-country testing would allow for faster initiation of infants on life-saving treatment
ACKNOWLEDGEMENTS
• Funding for this research was provided by the University of California Los Angeles (UCLA) student dance marathon program.
• We would like to acknowledge:– The MOH of Lesotho– Health care workers in the sites– The research team and all EGPAF staff– Our patients
Thank you!
