1 Towards getting more HIV- positive infants on lifesaving treatment: assessing turn- around times...
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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
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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.
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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
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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
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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
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Step-by-step DNA-PCR testing in Lesotho
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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
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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
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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
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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
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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
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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.
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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
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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
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Thank you!