Abstract
Novel approaches to case identification and linkage to antiretroviral therapy (ART) are needed to close gaps in early infant diagnosis (EID) of HIV. Point-of-care (POC) EID is a recent innovation that eliminates the long turnaround times of conventional EID that limit patient management in the inpatient setting. The initial deployment of POC EID in Mozambique focused primarily on outpatient clinics; however, 2 high-volume tier-4 pediatric referral hospitals were also included. To assess the impact of inpatient POC EID, a retrospective review of testing and care data from Hospital Central de Beira (HCB) and Hospital Central de Maputo (HCM) was performed for the period September 2017 to July 2018, with comparison to the 8-month pre-POC period when dried blood spots were used for conventional EID. Monthly testing volume increased from 8.5 tests pre-POC to 17.6 tests with POC (P<.001). Among 511 children with POC testing, the median age was 5 months, there was ongoing breastfeeding in 326 (63.8%), and 136 (26.6%) of mothers and 146 (28.6%) of infants had not received ART or antiretroviral prophylaxis, respectively. POC tests were positive in 152 (29.7%) infants, and 52 (37.5%) had a previous negative DNA polymerase chain reaction through the conventional outpatient EID program. Linkage to ART for infants with HIV-positive tests improved 64% during the POC period (P=.002). Inpatient mortality for infected infants during the POC period was 28.2%. Excluding these deaths, 61.2% of eligible infants initiated ART as inpatients, but only 29.8% of those discharged without ART were confirmed to have initiated as outpatients. Inpatient wards are a high-yield site for EID and ART initiation that have historically been overlooked in programming for prevention of mother-to-child transmission. POC platforms represent a transformative opportunity to increase inpatient testing, make definitive diagnoses, and improve timely linkage to ART. Scale-up plans should prioritize pediatric wards.
Highlights
Novel approaches to case identification and linkage to antiretroviral therapy (ART) are needed to close gaps in early infant diagnosis (EID) of HIV
This study was a retrospective review of routine EID testing and patient care data from Hospital Central de Maputo (HCM) and Hospital Central de Beira (HCB), tier-4 reference hospitals providing the highest level of care in the public sector in the southern and central regions of Mozambique, respectively
A total of 511 HIV-exposed infants (HEI) were tested with POC at both hospitals during the study period (330 patients over 18 months at HCB, and 181 patients over 11 months at HCM)
Summary
Novel approaches to case identification and linkage to antiretroviral therapy (ART) are needed to close gaps in early infant diagnosis (EID) of HIV. In Mozambique, only an estimated 50% of HIV-infected children were on ART at the end of 2018, compared with a 55% coverage rate in adults.[1,2] Low pediatric coverage rates can, in part, be attributed to significant challenges with retention of Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique www.ghspjournal.org mother–infant pairs in prevention of mother-tochild transmission (PMTCT) services with only. Conventional EID 62% of exposed infants of women living with HIV programs do not enrolled in antenatal care having an early infant diadequately serve agnosis (EID) virologic test by 2 months of age in pediatric inpatient 2018.1 For HIV-exposed infants (HEI) retained in wards and care, the complexity of establishing the HIV status represent a missed opportunity to reduce the impact of HIV in children. Point-of-care (POC) testing for EID is a recent innovation that permits health care systems to decentralize testing and bypass the inefficient networks needed for centralized testing platforms.[3]
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