Abstract
Early infant diagnosis (EID) of HIV-1 infection confers substantial benefits to HIV-infected and HIV-uninfected infants, to their families, and to programs providing prevention of mother-to-child transmission (PMTCT) services, but has been challenging to implement in resource-limited settings. In order to correctly inform parents/caregivers of infant infection status and link HIV-infected infants to care and treatment, a 'cascade' of events must successfully occur. A frequently cited barrier to expansion of EID programs is the cost of the required laboratory assays. However, substantial implementation barriers, as well as personnel and infrastructure requirements, exist at each step in the cascade. In this update, we review challenges to uptake at each step in the EID cascade, highlighting that even with the highest reported levels of uptake, nearly half of HIV-infected infants may not complete the cascade successfully. We next synthesize the available literature about the costs and cost effectiveness of EID programs; identify areas for future research; and place these findings within the context of the benefits and challenges to EID implementation in resource-limited settings.
Highlights
Mother-to-child transmission (MTCT) of HIV-1 results in approximately 370,000 infant infections worldwide each year [1]
Opportunities to optimize infant outcomes may be lost at each step in a ‘cascade’ of early infant diagnosis (EID) and pediatric HIV care (Figure 1), conceptually similar to the recently described ‘cascade’ of care required for effective prevention of mother-to-child transmission (PMTCT) services [5]
The EID cascade includes the offer and acceptance of EID testing among HIV-exposed infants, including those for whom HIV exposure was unknown; accurate specimen collection, transport, and laboratory processing; relay of results to both healthcare providers and infants’ families/caregivers; and linkage to care, cotrimoxazole prophylaxis, and antiretroviral therapy (ART) for infants identified as HIV infected
Summary
Mother-to-child transmission (MTCT) of HIV-1 results in approximately 370,000 infant infections worldwide each year [1]. A frequently cited barrier to expansion of EID programs is the availability and cost of the required laboratory assays, which are usually PCR based and more expensive than the antibody-based testing used for older children and adults [3,4]. The EID cascade includes the offer and acceptance of EID testing among HIV-exposed infants, including those for whom HIV exposure was unknown; accurate specimen collection, transport, and laboratory processing; relay of results to both healthcare providers and infants’ families/caregivers; and linkage to care, cotrimoxazole prophylaxis, and antiretroviral therapy (ART) for infants identified as HIV infected. Available assays for early infant diagnosis In adults and older children, chronic HIV-1 infection can be diagnosed accurately by detection of serum
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
