scholarly journals Point of Care (POC) for Early Infant Diagnosis (EID) in Nigeria? Healthcare Workers Opinion

2021 ◽  
Vol 9 (1) ◽  
pp. 87-94
Author(s):  
Busari Olusegun
Keyword(s):  
Healthcare Workers ◽  
Point Of Care ◽  
Standard Of Care ◽  
Turnaround Time ◽  
Early Infant Diagnosis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Early Infant ◽  
Hiv Exposed

Without access to life-saving drugs, including antiretroviral, about one-third of HIV exposed infants (HEI) will die by age 1 year and 50% by age 2 years. A 75% reduction in disease progression and 76% reduction in HIV mortality in infants has been attributed to early diagnosis of HIV and early commencement on ART. Early Infant Diagnosis (EID) of HIV aids timely commencement on antiretroviral therapy (ART). Several challenges have been identified with the current process. Point of care (POC) technologies are recommended as a veritable means of addressing these challenges and improving EID uptake. With the aim of assessing the standard of care and the acceptability of POC for the provision of EID. A descriptive cross-sectional survey was conducted across eight healthcare facilities in Nigeria. The survey was conducted among 72 healthcare workers using self-administered questionnaire; with a recovery rate of 61(84.7%). Analysis of participants’ responses indicate that 100% of the respondents believes there is a need for EID. Most respondent reported an average turnaround time (TAT) of 3-4 weeks (35.8%) and >6 weeks (34.0%). Most respondents identified distance to the PCR laboratories (45.7%) and long TAT (34.8%) as key issues affecting the conduct of EID. On the benefit of POC for EID; 90.2% of respondent believe it is beneficial; while 81.5% of respondent believe that with the introduction and use of POC for EID there will be an increase in EID uptake. The POC is a viable and acceptable alternative for EID to increase uptake.

scholarly journals Accuracy and Feasibility of Point of Care (POC) Early Infant Diagnosis (EID) in Nigeria: A Field Evaluation

2021 ◽  
Vol 9 (1) ◽  
pp. 95-104
Author(s):  
Busari Olusegun
Keyword(s):  
Point Of Care ◽  
Standard Of Care ◽  
Field Evaluation ◽  
Turnaround Time ◽  
Early Infant Diagnosis ◽  
Hiv Diagnosis ◽  
Healthcare Facilities ◽  
Early Infant ◽  
Hiv Positive Mothers ◽  
First Time

The timely commencement of treatment within the first 12 weeks of life in children reduces the HIV disease progression by 75% and mortality by 76%. For all children infected with HIV to receive essential treatment and care, few things are more important than early and accurate HIV diagnosis. Traditional methods of providing Early Infant Diagnosis (EID) have been bedeviled with several challenges. Point of Care (POC) testing for EID has been recommended as a game-changer. A field evaluation was conducted across 6 healthcare facilities between February 2017 and August 2018 to determine the accuracy and operational feasibility of POC testing for EID in Nigeria. The conceptual framework rides on the WHO SDI ASSURED criteria. Participants were infants aged between 4 weeks and 18 months born to HIV-positive mothers and visiting the clinic for the first time for EID. Results obtained from the POC was compared with the Standard of Care (SOC) to determine accuracy and feasibility. A total of 245 participants took part in the study, with 76% visiting the clinic for EID within 2 months of life. The average turnaround time for EID test using the SOC was 67 days. Analysis of the 10.4% error rate indicate significant correlation by personnel (r= 0.01122, P=0.841706). An average concordance percentage of 99.6%, sensitivity of 91.7% and specificity of 100.0% was observed. Operator’s assessment indicates that the equipment is very good and acceptable. The POC testing for EID is acceptable, rapid, and robust; hence, viable for use in Nigeria.

scholarly journals Strategic site selection for placement of HIV early infant diagnosis point-of-care technology within a national diagnostic network in Lesotho

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Anafi Mataka ◽  
Esther A.J. Tumbare ◽  
Tsietso Motsoane ◽  
David Holtzman ◽  
Monkoe Leqheka ◽  
...  
Keyword(s):  
New Technologies ◽  
Point Of Care ◽  
Optimal Placement ◽  
Early Infant Diagnosis ◽  
Local Networks ◽  
Hub And Spoke ◽  
Early Infant ◽  
Infrastructure Investments ◽  
Hiv Exposed ◽  
Care Technology

Background: New technologies for rapid point-of-care (POC) diagnostic tests hold great potential for improving the health outcomes of HIV-exposed infants. POC testing for HIV early infant diagnosis (EID) was introduced in Lesotho in late 2016. Here we highlight critical requirements for selecting routine POC EID sites to ensure a sustainable and optimised EID diagnostic network.Intervention: Lesotho introduced POC EID in a phased approach that included assessments of national databases to identify sites with high test volumes, the creation of local networks of sites to potentially increase access to POC EID, and a standardised capacity assessment to determine site readiness. Potential site networks comprising ‘hub’ testing sites and ‘spoke’ specimen referring sites were created.Lessons learnt: After determining optimal placement, a total of 29 testing facilities were selected for placement of POC EID to potentially increase access to 189 facilities through the use of a hub-and-spoke model. Site capacity assessments identified vital human resources and infrastructure capacity gaps that needed to be addressed before introducing POC EID and informed appropriate POC platform selection.Recommendations: POC placement involves more than just purchasing the testing platforms. Considering the relatively small proportion of sites that can be eligible for placement of a POC platform, utilising a hub-and-spoke model can maximise the number of health facilities served by a POC platform while reducing the necessary capacity building and infrastructure investments to fewer sites.

scholarly journals Operational experiences associated with the implementation of near point-of-care early infant diagnosis of HIV in Myanmar: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Win Lei Yee ◽  
Hla Htay ◽  
Yasmin Mohamed ◽  
Claire E. Nightingale ◽  
Htay Htay Tin ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Technical Assistance ◽  
Point Of Care ◽  
Scale Up ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Early Infant Diagnosis ◽  
Structured Interviews ◽  
Early Infant ◽  
The Impact

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.

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

scholarly journals Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Michelle M. Gill ◽  
Heather J. Hoffman ◽  
Majoalane Mokone ◽  
Vincent J. Tukei ◽  
Matsepeli Nchephe ◽  
...  
Keyword(s):  
Turnaround Time ◽  
Early Infant Diagnosis ◽  
Blood Draw ◽  
Hiv Exposed Infants ◽  
Art Initiation ◽  
Early Infant ◽  
Hiv Test ◽  
Observational Prospective Cohort Study ◽  
Hiv Exposed ◽  
Birth Testing

Very early infant diagnosis (VEID) (testing within two weeks of life), combined with rapid treatment initiation, could reduce early infant mortality. Our study evaluated turnaround time (TAT) to receipt of infants’ HIV test results and ART initiation if HIV-infected, with and without birth testing availability. Data from facility records and national databases were collected for 12 facilities offering VEID, as part of an observational prospective cohort study, and 10 noncohort facilities. HIV-exposed infants born in January–June 2016 and any cohort infant diagnosed as HIV-infected at birth or six weeks were included. The median TAT from blood draw to caregiver result receipt was 76.5 days at birth and 63 and 70 days at six weeks at cohort and noncohort facilities, respectively. HIV-exposed infants tested at birth were approximately one month younger when their caregivers received results versus those tested at six weeks. Infants diagnosed at birth initiated ART about two months earlier (median 6.4 weeks old) than those identified at six weeks (median 14.8 weeks). However, the long TAT for testing at both birth and six weeks illustrates the prolonged process for specimen transport and result return that could compromise the effectiveness of adding VEID to existing overburdened EID systems.

scholarly journals Point-of-care p24 antigen detection for early infant diagnosis of HIV infection: cross-sectional and longitudinal studies in Zambia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catherine G. Sutcliffe ◽  
Jane Mutanga ◽  
Nkumbula Moyo ◽  
Abhishek K. Agarwal ◽  
Jessica L. Schue ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Rural Areas ◽  
Point Of Care ◽  
High Specificity ◽  
Early Infant Diagnosis ◽  
Cross Sectional ◽  
Early Infant ◽  
Moderate Sensitivity ◽  
P24 Antigen ◽  
Hospital Study

Abstract Background Early infant diagnosis of HIV infection is challenging in sub-Saharan Africa, particularly in rural areas, leading to delays in diagnosis and treatment. Use of a point-of-care test would overcome many challenges. This study evaluated the validity of a novel point-of-care p24 antigen detection test (LYNX) in rural and urban settings in southern Zambia. Methods Two studies were conducted: a cross-sectional study from 2014 to 2015 at Macha Hospital (LYNX Hospital study) and a longitudinal study from 2016 to 2018 at 12 health facilities in Southern Province, Zambia (NSEBA study). In both studies, children attending the facilities for early infant diagnosis were enrolled and a blood sample was collected for routine testing at the central lab and immediate on-site testing with the LYNX test. The performance of the LYNX test was measured in comparison to nucleic acid-based testing at the central lab. Results In the LYNX Hospital study, 210 tests were performed at a median age of 23.5 weeks (IQR: 8.9, 29.0). The sensitivity and specificity of the test were 70.0 and 100.0%, respectively. In the NSEBA study, 2608 tests were performed, including 1305 at birth and 1222 on children ≥4 weeks of age. For samples tested at birth, sensitivity was 13.6% (95% CI: 2.9, 34.9) and specificity was 99.6% (95% CI: 99.1, 99.9). While specificity was high for all ages, sensitivity increased with age and was higher for participants tested at ≥4 weeks of age (80.6%; 95% CI: 67.4, 93.7). Children with positive nucleic acid tests were more likely to be negative by the LYNX test if their mother received antiretroviral therapy during pregnancy (60.7% vs. 24.2%; p = 004). Conclusions Considering the high specificity and moderate sensitivity that increased with age, the LYNX test could be of value for early infant diagnosis for infants ≥4 weeks of age, particularly in rural areas where centralized testing leads to long delays. Point-of-care tests with moderate sensitivity and high specificity that are affordable, easy-to-use, and easily implemented and maintained should be developed to expand access to testing and deliver same-day results to infants in areas where it is not feasible to implement nucleic acid-based point-of-care assays.

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