Abstract
BackgroundEarly identification of HIV-infected infants for treatment is critical for survival. Efficient uptake of early infant diagnosis (EID) requires timely presentation of HIV-exposed infants, same-day sample collection, and prompt release of results. The MoMent (Mother Mentor) Nigeria study investigated the impact of structured peer support on EID presentation and maternal retention. This cascade analysis highlights missed opportunities for EID and infant treatment initiation during the study.MethodsHIV-infected pregnant women and their infants were recruited at 20 rural Primary Healthcare Centers. Routine infant HIV DNA PCR testing was performed at centralized laboratories using dried blood spot (DBS) samples ideally collected by age two months. EID outcomes data were abstracted from study case report forms and facility registers. Descriptive statistics summarized gaps and missed opportunities in the EID cascade.ResultsOut of 497 women enrolled, delivery data was available for 445 (90.8%), to whom 415 of 455 (91.2%) infants were live-born. Out of 408 live-born infants with available data, 341 (83.6%) presented for DBS sampling at least once. Only 75.4% (257/341) were sampled, with 81.7% (210/257) sampled at first presentation. Only 199/257 (77.4%) sampled infants had results available up to 28 months post-collection. Two (1.0%) of the 199 infants tested HIV-positive; one infant died before treatment initiation and the other was lost to follow-up.ConclusionsWhile nearly 85% of infants presented for sampling, there were multiple missed opportunities, largely due to health system and not necessarily patient-level failures. These included infants presenting without being sampled, presenting multiple times before samples were collected, and getting sampled but results not forthcoming. Finally, neither of the two HIV-positive infants were linked to treatment within the follow-up period, which may have led to the death of one. To facilitate patient compliance and HIV-free infant survival, quality improvement approaches should be optimized for EID commodity availability, consistent DBS sample collection, efficient processing/result release, and prompt infant treatment initiation.
Highlights
The persistence of HIV transmission between women living with HIV and their HIV-exposed infants (HEI) is a serious public health concern
To facilitate patient compliance and HIV-free infant survival, quality improvement approaches should be optimized for early infant diagnosis (EID) commodity availability, consistent dried blood spot (DBS) sample collection, efficient processing/result release, and prompt infant treatment initiation
This paper examines the programmatic aspect of the EID presentation outcome and provides a cascade analysis of EID presentation, testing and result delivery for all infants enrolled in the study
Summary
The persistence of HIV transmission between women living with HIV and their HIV-exposed infants (HEI) is a serious public health concern. In high HIV–burden countries, vertically-transmitted HIV contributes significantly to infant mortality rates [3]. Prevention of mother-to-child-transmission of HIV (PMTCT) programs aim to reduce and eliminate vertical transmission of HIV, and to facilitate maternal and infant health and survival [4, 5]. The PMTCT agenda aligns with the SDG agenda in their mutual objective of reducing maternal and infant mortality globally. Identification of HIV-infected infants for treatment is critical for survival. The MoMent (Mother Mentor) Nigeria study investigated the impact of structured peer support on EID presentation and maternal retention. This cascade analysis highlights missed opportunities for EID and infant treatment initiation during the study
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