scholarly journals Trends in uptake of early infant diagnosis for HIV: implementation results of the Ugandan military PMTCT program

2021 ◽  
Vol 8 (6) ◽  
pp. 2746
Author(s):  
Paul Lubega ◽  
Stephen Lawoko ◽  
Filbert Akatukunda ◽  
Gloria Seruwagi ◽  
John Bosco Ninsima ◽  
...  
Keyword(s):  
Positive Impact ◽  
Data Extraction ◽  
Statistical Significance ◽  
Hiv Positive ◽  
Early Infant Diagnosis ◽  
Cross Sectional ◽  
Early Infant ◽  
Short Period ◽  
Rapid Tests ◽  
Military Facilities

Background: Early infant diagnosis (EID) is an important strategy of the Prevention of Mother-to-child transmission (PMTCT) and when implemented in combination with other strategies could eliminate HIV MTCT. We implemented a series of strategic interventions intended to improve EID at 9 Military facilities in Uganda and evaluated their impact on uptake of EID.Methods: A retrospective cross-sectional design was adopted, following-up HIV Exposed Infants (HEI) at the study sites over a 2 year period, and using a data extraction tool to capture4 indicators of EID namely; number of HIV-positive mothers, number of HEI enrolled, number of PCR and rapid tests performed on HEI, and number of HIV-positive results of HEI. Scatter plots and simple linear regression were applied to demonstrate trends in EID uptake and estimate intervention impact over time. Statistical significance was assumed at p<0.05.Results: We established incremental trends in numbers of first PCR (f [1,6]=2.8; p=0.15),third PCR (f [1,6]=8.4; p<0.05), rapid tests (f [1,6]=16.1; p<0.05) performed on HEI, and a modest decline in HIV-positivity among HEI over the study period. The intervention improved retention in PMTCT cascade to 80%, when contrasted with the national average of 70%.Conclusions: We have demonstrated that interventions invoking pre-booking HIV-positive pregnant mothers during antenatal care, follow up of mother-baby pairs using telephone and mentor mothers and integrating EID in immunization programs can improve uptake of EID in a relatively short period, and with a positive impact on EID indicators.

scholarly journals PMTCT Service Uptake among Pregnant Women in 3 Internally Displace Persons Camps in Borno State Northeast Nigeria

2020 ◽  
pp. 72-77
Author(s):  
Affiah Nsikan ◽  
Fadoju Sunkanmi ◽  
Dickson Peter ◽  
Jasini Joseph ◽  
Opada Emmanuel ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Transmission ◽  
Data Extraction ◽  
Healthcare Services ◽  
Hiv Positive ◽  
Pmtct Service ◽  
Early Infant Diagnosis ◽  
North East ◽  
Early Infant ◽  
Hiv Positive Mothers

Background: Humanitarian emergencies upset and wreck existing healthcare services and systems. Pregnant women and infant are incredibly defenseless, as these infants are exposed to the risk of preventable childhood disease which includes HIV that is transmitted from their HIV positive mother. In the absence of any intervention, the risk of HIV transmission increases to about 40% among infant born to HIV positive mothers. Objectives: To examine the prevalence and uptake of HIV services among pregnant women and to assess the level of Early Infant Diagnosis (EID) by PCR uptake for children under 2 months born to HIV positive mothers. Methods: A sentinel case study approach conducted in 3 internally displaced people (IDP) camps in 3 LGAs (Banki, Dikwa and Ngala) of Borno state Nigeria, from January 2018 to May 2019. Data collected using standard tools and DHIS 2.0 used for data extraction and MS Excel used for analysis. Results: Prevalence of HIV among pregnant women (1st ANC Visits) in the 3 IDP camps were 1.22% (Ngala), 0.44% (Banki) and 0.16% (Dikwa) with an average of 0.61% compared to the 2018 National zonal average for the North East of1.1%. Uptake of HIV testing service among pregnant women in the 3 IDP camps were 90.65% (Ngala), 100% (Banki) and 100% (Dikwa), with an average uptake of 96.9%; while EID uptake for HIV exposed children within 2 months of age were: 50.0% (Dikwa), 12.5% (Banki) and 0% (Ngala). Conclusions: The study also shows that none of the 3 IDP camps were able to optimize Early Infant Diagnosis at 2 months of birth. It is hereby recommended that Care-giver Focused Approach should be prioritized in preventing mother-to-child transmission (PMTCT) service delivery.

scholarly journals Barriers to early infant diagnosis of HIV in the Wa Municipality and Lawra District of Upper West Region, Ghana

2020 ◽  
Vol 54 (2) ◽  
pp. 83-90
Author(s):  
Robert Nuoh ◽  
Kofi Nyarko ◽  
Charles Noora ◽  
Adolphina Addo-Lartey ◽  
Priscillia Nortey ◽  
...  
Keyword(s):  
Formal Education ◽  
Transmission Rate ◽  
Hiv Positive ◽  
Early Infant Diagnosis ◽  
Independent Source ◽  
Positive Mother ◽  
West Region ◽  
Early Infant ◽  
Exposed Infant ◽  
Wa Municipality

Objective: We identified socio-demographic, health system and psycho-social barriers to Early Infant Diagnosis (EID) of HIV in the Upper West Region of Ghana.Design: An unmatched case control study of 96 cases and 96 controls was conducted in the ART centers in Lawra district and Wa Municipality between December 2014 and April 2015.Setting: A public health facilityParticipants: We defined a case as an HIV positive mother with an exposed infant who received EID service between January 2011 and December 2014. A control was defined as HIV Positive Mother with an exposed infant who did not receive EID services between January 2011 and December 2014.Main outcome: EID by dry blood spot Deoxyribonucleic acid Polymerase chain reaction.Results: A total of 192 mother-infant pairs were assessed. The mean age of infants at testing for cases was 17.3±14.9 weeks. Mother-to-child-transmission-rate was 2.3%. Factors associated with EID testing included: mother being formallyemployed (cOR=2.0: 95%CI:1.1-3.8), maternal formal education (cOR=2.0, 95%CI: 1.1-3.6) and maternal independent source of income (cOR 2.2, 95%CI 1.2-4.1). After adjusting for confounders, maternal independent incomebsource was associated with EID testing (aOR 2.2, 95%CI 1.2-4.1). Median turn-around time of EID result was 11 weeks (IQR 4-27weeks).Conclusion: Women need to be empowered to gain an independent source of income. This can help maximize the benefits of e-MTCT and increase EID in the Upper West Region of Ghana.Keywords: Barriers; HIV; early infant diagnosis; DNA-PCR; GhanaFunding: This work was funded by the authors

scholarly journals Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e043679
Author(s):  
Yasmin Mohamed ◽  
Martha Kupul ◽  
Janet Gare ◽  
Steven G Badman ◽  
Selina Silim ◽  
...  
Keyword(s):  
Papua New Guinea ◽  
Standard Care ◽  
Health Workers ◽  
Point Of Care ◽  
Hiv Positive ◽  
Early Infant Diagnosis ◽  
Pmtct Programme ◽  
Early Infant ◽  
Qualitative Exploration ◽  
Hiv 1

IntroductionEarly infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy can significantly reduce morbidity and mortality among HIV-positive infants. Access to EID is limited in many low-income and middle-income settings, particularly those in which standard care involves dried blood spots (DBS) sent to centralised laboratories, such as in Papua New Guinea (PNG). We conducted a qualitative exploration of the feasibility and acceptability of implementing a point-of-care (POC) EID test (Xpert HIV-1 Qualitative assay) among health workers and key stakeholders working within the prevention of mother-to-child transmission of HIV (PMTCT) programme in PNG.MethodsThis qualitative substudy was conducted as part of a pragmatic trial to investigate the effectiveness of the Xpert HIV-1 Qualitative test for EID in PNG and Myanmar. Semistructured interviews were undertaken with 5 health workers and 13 key informants to explore current services, experiences of EID testing, perspectives on the Xpert test and the feasibility of integrating and scaling up POC EID in PNG. Coding was undertaken using inductive and deductive approaches, drawing on existing acceptability and feasibility frameworks.ResultsHealth workers and key informants (N=18) felt EID at POC was feasible to implement and beneficial to HIV-exposed infants and their families, staff and the PMTCT programme more broadly. All study participants highlighted starting HIV-positive infants on treatment immediately as the main advantage of POC EID compared with standard care DBS testing. Health workers identified insufficient resources to follow up infants and caregivers and space constraints in hospitals as barriers to implementation. Participants emphasised the importance of adequate human resources, ongoing training and support, appropriate coordination and a sustainable supply of consumables to ensure effective scale-up of the test throughout PNG.ConclusionsImplementation of POC EID in a low HIV prevalence setting such as PNG is likely to be both feasible and beneficial with careful planning and adequate resources.Trial registration number12616000734460.

scholarly journals Perinatally acquired HIV-positive status disclosure and associated factors in Dire Dawa and Harar, Eastern Ethiopia: a health facility-based cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e019554 ◽  
Author(s):  
Melkamu Merid Mengesha ◽  
Yadeta Dessie ◽  
Aklilu Abrham Roba
Keyword(s):  
Health Status ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Eastern Ethiopia ◽  
Dire Dawa

ObjectivesThe aim of this study was to assess the level and factors associated with caregivers’ disclosure of perinatally HIV-infected (PHIV+) children’s seropositive status.DesignWe conducted a cross-sectional study in five public health facilities providing HIV treatment and care in Dire Dawa and Harar, Eastern Ethiopia. The data were collected from 310 caregivers through face-to-face interviews and record reviews. Data analyses were done using STATA V.14.2 and statistical significance was declared at p value <0.05.ResultsThe study revealed that the level of PHIV+ diagnosis disclosure was 49.4% (95% CI 43.8 to 54.9). Mean age at disclosure was 11.2 years. Disclosure level was higher among children who frequently asked about their health status (aOR (adjusted OR) 2.04, 95% CI 1.04 to 4.03) and when caregivers knew other people who had a disclosure experience (aOR 2.49, 95% CI 1.17 to 5.32). Disclosure level was less among children of 12 years or below (aOR 0.04, 95% CI 0.02 to 0.09) and among caregivers practising deception about the children’s HIV positive status (aOR 0.38, 95% CI 0.19 to 0.74).ConclusionOnly half of the caregivers disclosed their child’s PHIV+ diagnosis. To facilitate disclosure, caregivers should be counselled about the appropriate age of disclosure and related misconceptions that hinder it. It is also apparent that caregivers need to be guided as to how to address children’s frequent questions about their health status. These interventions can be made in a one-on-one approach or through patient group counselling when they come to get healthcare services.

scholarly journals Correlates and determinants of Early Infant Diagnosis outcomes in North-Central Nigeria

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Patrick Dakum ◽  
Monday Tola ◽  
Nta Iboro ◽  
Chukwuemeka A. Okolo ◽  
Olachi Anuforom ◽  
...  
Keyword(s):  
Linear Trend ◽  
Scale Up ◽  
Cross Sectional Study ◽  
Early Infant Diagnosis ◽  
Sample Collection ◽  
Cross Sectional ◽  
Timely Initiation ◽  
Significant Linear Trend ◽  
North Central ◽  
Early Infant

Abstract Background A negative status following confirmatory Early Infant Diagnosis (EID) is the desired pediatric outcome of prevention of Mother to Child Transmission (PMTCT) programs. EID impacts epidemic control by confirming non-infected HIV-exposed infants (HEIs) and prompting timely initiation of ART in HIV-infected babies which improves treatment outcomes. Objectives We explored factors associated with EID outcomes among HEI in North-Central Nigeria. Method This is a cross-sectional study using EID data of PMTCT-enrollees matched with results of HEI’s dried blood samples (DBS), processed for DNA-PCR from January 2015 through July 2017. Statistical analyses were done using SPSS version 20.0 to generate frequencies and examine associations, including binomial logistic regression with p < 0.05 being statistically significant. Results Of 14,448 HEI in this analysis, 51.8% were female and 95% (n = 12,801) were breastfed. The median age of the infants at sample collection was 8 weeks (IQR 6–20), compared to HEI tested after 20 weeks of age, those tested earlier had significantly greater odds of a negative HIV result (≤ 6 weeks: OR = 3.8; 6–8 weeks: OR = 2.1; 8–20 weeks: OR = 1.5) with evidence of a significant linear trend (p < 0.001). Similarly, HEI whose mothers received combination antiretroviral therapy (cART) before (OR = 11.8) or during the index pregnancy (OR = 8.4) had significantly higher odds as compared to those whose mothers did not receive cART. In addition, HEI not breastfed had greater odds of negative HIV result as compared to those breastfed (OR = 1.9). Conclusions cART prior to and during pregnancy, earlier age of HEI at EID testing and alternative feeding other than breastfeeding were associated with an increased likelihood of being HIV-negative on EID. Therefore, strategies to scale-up PMTCT services are needed to mitigate the burden of HIV among children.

Characteristics and outcomes of HIV-exposed infants in Homa Bay County, Kenya, 2015

2020 ◽  
Vol 50 (2) ◽  
pp. 154-156
Author(s):  
Lawrence K Gitonga ◽  
Waqo G Boru ◽  
Lilly Muthoni ◽  
Jacob Odhiambo ◽  
James Ransom
Keyword(s):  
Antenatal Care ◽  
Retrospective Review ◽  
Hiv Positive ◽  
Early Infant Diagnosis ◽  
Western Kenya ◽  
Replacement Feeding ◽  
Hiv Exposed Infants ◽  
Care Services ◽  
Early Infant ◽  
Hiv Exposed

Homa Bay County in south-western Kenya has a low uptake of antenatal care services and the highest prevalence of HIV in the country. We present the findings of a retrospective review of HIV-exposed infants (HEI) who sought early infant diagnosis services in the county throughout 2015. HEI who were breastfed >6 months, had replacement feeding and did not receive prophylaxis were 2–6 times more likely to be HIV-positive.

scholarly journals Inadequate dried blood spot samples for Early Infant Diagnosis, how common and what are the reasons for rejection in Zimbabwe?

2018 ◽  
Author(s):  
Charles Chiku ◽  
Maria Zolfo ◽  
Mbazi Senkoro ◽  
Mzwandile Mabhala ◽  
Hannock Tweya ◽  
...  
Keyword(s):  
Rejection Rate ◽  
Cross Sectional Study ◽  
Dried Blood Spot ◽  
Reference Laboratory ◽  
Early Infant Diagnosis ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Early Infant ◽  
Blood Spot ◽  
Rejection Rates

Background: Early infant diagnosis (EID) of HIV in infants provides an opportunity for early detection of the infection and early access to Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of HIV-exposed infants, born from HIV positive mothers. However, DBS rejection rates have been exceeding in Zimbabwe the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL). The aim of this study was to determine the DBS samples rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the sample was collected. Methods: Analytic cross-sectional study using routine DBS samples data from the NMRL in Harare, Zimbabwe, between January and December 2017. Results: A total of 34.950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected and reasons for rejections were: insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross contamination (6%), mismatch information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities had five times likelihood to be rejected compared to those from a central hospital. Conclusion: Rejection rates were above the set target of 2%. The reasons for rejection were 'pre-analytical' errors including labeling errors, sample damage, missing or inconsistent data, and insufficient volume. Samples collected at primary healthcare facilities had higher rejection rates. Key words: Operational Research, SORT IT, Early Infant Diagnosis, Dried Blood Spot

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