Abstract
BackgroundAt-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya.MethodsWe conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources.ResultsMost providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before–possibly–learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier.DiscussionWhile overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.
Highlights
Infant diagnosis of HIV (EID) is critical to identify HIV-positive infants and initiate them on antiretroviral therapy (ART)
Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before–possibly–learning that their child was HIV
Inefficiencies along the Early infant diagnosis of HIV (EID) cascade of care,[1,2,3,4] result in Kenyan infants not being initiated on ART until a median age of 17.1–25.1 weeks.[4, 5]
Summary
Infant diagnosis of HIV (EID) is critical to identify HIV-positive infants and initiate them on antiretroviral therapy (ART). Testing infants at birth with more efficient point of care [POC] HIV diagnostic technology is emerging as a strategy to streamline EID and minimize challenges with traditional central laboratory based HIV DNA PCR testing at 6-weeks of age. Testing HIV-exposed infants at birth using POC technologies can result in more HIV-positive infants being identified and initiated on ART at younger ages than traditional testing strategies.[9,10,11] In Lesotho, HIV DNA PCR testing for HIV-exposed infants within 2 weeks of birth reduced infant age at ART initiation from 14.6 weeks to 6.1 weeks.[12] In a South African pilot study evaluating POC technologies, the median time from sample collection to HIV-positive infant ART initiation was reduced from 18 weeks with standard HIV DNA PCR testing to 0 days with POC.[13] Studies have found that POC implementation is feasible in health facility-based settings in Kenya,[14] South Africa,[10, 15, 16] Mozambique,[17] and Tanzania[18] and is acceptable to providers.[16] Based on this evidence, Kenya and other countries are incorporating at-birth and POC testing into national plans for EID.[19,20,21].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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.
