Abstract
BackgroundEarly infant HIV diagnosis is challenging in sub-Saharan Africa, particularly in rural areas where laboratory capacity is limited. Specimens must be transported to central laboratories for testing, leading to delays in diagnosis and initiation of antiretroviral therapy. This study was undertaken in rural Zambia to measure the turnaround time for confirmation of HIV infection and identify delays in diagnosis.MethodsChart reviews were conducted from 2010–2012 for children undergoing early infant HIV diagnosis at Macha Hospital in Zambia. Relevant dates, receipt of drugs by mother and child for the prevention of mother-to-child transmission (PMTCT), and test results were abstracted.Results403 infants provided 476 samples for early infant diagnosis. The median age at the “6-week” and “6-month” assessments was 8.1 weeks and 7.0 months, respectively. The majority of mothers (80%) and infants (67%) received PMTCT. The median time between sample collection and arrival at the central laboratory in Lusaka was 17 days (IQR: 10, 28); arrival at the central laboratory to testing was 6 days (IQR: 5, 11); testing to return of results to the clinic was 29 days (IQR: 17, 36); arrival of results at the clinic to return of results to the caregiver was 45 days (IQR: 24, 79). The total median time from sample collection to return of results to the caregiver was 92 days (IQR: 84, 145). The proportion of HIV PCR positive samples was 12%. The total median turnaround time was shorter for HIV PCR positive as compared to negative or invalid samples (85 vs. 92 days; p = 0.08).ConclusionsDelays in processing and communicating test results were identified, particularly in returning results from the central laboratory to the clinic and from the clinic to the caregiver. A more efficient process is needed so that caregivers can be provided test results more rapidly, potentially resulting in earlier treatment initiation and better outcomes for HIV-infected infants.
Highlights
Over 90% of the world’s 3.3 million HIV-infected children reside in sub-Saharan Africa where resources for providing care and treatment are most limited [1]
In this study of turnaround times for early infant HIV diagnosis test results in a rural clinic in southern Zambia, the median time from sample collection to return of the results to the caregiver was 92 days
These findings suggest that reductions in turnaround time can be achieved by developing strategies to improve communication between the laboratory and the clinic, and between the clinic and caregiver
Summary
Over 90% of the world’s 3.3 million HIV-infected children reside in sub-Saharan Africa where resources for providing care and treatment are most limited [1]. Diagnosis of HIV infection in early infancy is challenging in sub-Saharan Africa, as assays based on HIV DNA or RNA detection must be used rather than the serologic assays used in older children and adults [4]. These assays require a higher level of technology, training and cost than is available in many clinics and district laboratories. Infant HIV diagnosis is challenging in sub-Saharan Africa, in rural areas where laboratory capacity is limited. This study was undertaken in rural Zambia to measure the turnaround time for confirmation of HIV infection and identify delays in diagnosis
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