Diagnosis Of HIV Infection In Infants Research Articles

Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centers in Lagos State, Nigeria

IntroductionNigeria has a low uptake of early infant diagnosis (EID) of HIV despite its high pediatric HIV infection rate. Efforts to increase the EID of HIV have been limited by many factors. This research assessed EID uptake and challenges service providers experienced in providing routine care for HIV-exposed infants.MethodsThis is a mixed-method study at primary health centers (PHCs) in Lagos state, Nigeria. The quantitative component of the research was a review of the PMTCT Infant Follow-up Register at a purposive sample of 22 PHCs of Lagos State. The number of HIV-exposed infants (HEIs) returned for a dried blood sample (DBS) collection, date of collection, and the infant’s EID results for one year preceding the study were captured on Research Electronic Data Capture (RedCap). In-depth interviews were conducted with service providers purposively selected per participating PHC. Electronic transcripts were analyzed using MAXQDA 2020 (VERBI Software, 2019).ResultsTwenty-two Lagos State primary health centers participated in the research. Fifteen PHCs (68.2%) had PMTCT HIV counseling and Infant follow-up registers. Documentation of DBS sample collection was observed in 12 (54.6%) PHCs. Both DBS sample collection and EID results documentation were observed in only nine (40.9%) PHCs. In-depth interviews revealed both maternal and health systems’ challenges to EID. The denial of HIV status was the only maternal factor reported as a barrier against the use of EID services. Health systems challenges include unavailability of EID services, uncertainty regarding whether EID is performed in a facility, referral to secondary health facilities for EID services (leading to losses to follow-up), and delay in getting results of EID. Task-shifting of DBS collection by nurses was suggested as means to increase access to EID services.ConclusionsThere is a need to expand EID services and address women’s denial of HIV infection. Counseling women and linkage to available services are emphasized. Re-training of health workers on DBS collection and proper documentation of EID services were noted as key to improving the implementation of early infant diagnosis of HIV in the state.

Economics of point-of-care infant HIV tests

Economics of point-of-care infant HIV tests

Early infant diagnosis of HIV infection at the John F. Kennedy Medical Center, Monrovia, Liberia

Background: Vertical transmission accounts for majority of new HIV infections among children worldwide. Ninety percent of HIV-positive children reside in Sub- Saharan Africa with their infection predominantly acquired via vertical transmission. In 2004, the vertical transmission rate of HIV in Africa was estimated at 25 − 40% but, remarkably, the rate has significantly decreased to less than 5% in most African countries following implementation and expansion of prevention of MTCT (PMTCT) programs. Objective: To determine the rate of and factors associated with vertical transmission of HIV among attendees of early infant diagnosis (EID) program of an academic and community-based tertiary facility in Liberia. Design: A retrospective cross-sectional analysis. Methods: A retrospective review of medical records of babies seen at Pediatric Unit of Infectious Disease Clinic of John F Kennedy Medical Center (JFKMC) in Monrovia, Liberia between January 1, 2016 and December 31, 2020. All subjects were children born to HIV-positive mothers and who had HIV DNA PCR testing performed between the ages of 6 weeks and 6 months. Children who suffered early neonatal death and those who did not undergo PCR testing were excluded. Demographics of mother to child pairs as well as factors known to influence vertical transmission of HIV such as partial (15.8%) or full (84.2%) participation in prevention of MTCT (PMTCT) programs, mode of delivery, breastfeeding and utilization of post-exposure prophylaxis were collected and assessed. Binomial logistic regression analyses were used to assess factors associated with vertical transmission. Results: During the study timeframe, 284 children had a HIV DNA PCR test with a male:female ratio − 1.3:1. Sixteen tested positive (conducted at a mean of 155 days post birth) giving a vertical transmission rate of 5.6%. For 239 mothers (84.2%) who had full PMTCT, 1.3% of their children tested positive, while for 45 mothers (15.8%) who had partial PMTCT, 28.8% of their children being positive. Two hundred and seventy six children (97%) had exclusive breastfeeding, 13 of whom tested positive while 2 children who were mixed fed tested positive. Children who had Nevirapine vs no prophylaxis (OR = 1.89[95% CI 1.16 − 2.96]), were delivered via caesarian section vs vaginal delivery (OR= 2.26[95% CI 1.92 − 4.12].) and full versus partial participation in PMTCT programs (OR = 4.02[95% CI 2.06 − 4.13] were more likely to have negative HIV test. Conclusion: Vertical transmission rate was found to be high in Liberia and may be driven by suboptimal PMTCT program participation including post-exposure prophylaxis for infants. Therefore, strategies to scale up and improve uptake of PMTCT services are needed to mitigate the burden of HIV among children.

Interventions to increase early infant diagnosis of HIV infection: A systematic review and meta-analysis

Early infant diagnosis (EID) of HIV infection increases antiretroviral therapy initiation, which reduces pediatric HIV-related morbidity and mortality. This review aims to critically appraise the effects of interventions to increase uptake of early infant diagnosis. This is a systematic review and meta-analysis of interventions to increase the EID of HIV infection. We searched PubMed, EMBASE, CINAHL, and PsycINFO to identify eligible studies from inception of these databases to June 18, 2020. EID Uptake at 4-8 weeks of age was primary outcome assessed by the review. We conducted meta-analysis, using data from reports of included studies. The measure of the effect of dichotomous data was odds ratios (OR), with a 95% confidence interval. The grading of recommendations assessment, development, and evaluation (GRADE) approach was used to assess quality of evidence. The review was not limited by time of publication or setting in which the studies conducted. HIV-exposed infants were participants. Database search and review of reference lists yielded 923 unique titles, out of which 16 studies involving 13,822 HIV exposed infants (HEI) were eligible for inclusion in the review. Included studies were published between 2014 and 2019 from Kenya, Nigeria, Uganda, South Africa, Zambia, and India. Of the 16 included studies, nine (experimental) and seven (observational) studies included had low to moderate risk of bias. The studies evaluated eHealth services (n = 6), service improvement (n = 4), service integration (n = 2), behavioral interventions (n = 3), and male partner involvement (n = 1). Overall, there was no evidence that any of the evaluated interventions, including eHealth, health systems improvements, integration of EID, conditional cash transfer, mother-to-mother support, or partner (male) involvement, was effective in increasing uptake of EID at 4-8 weeks of age. There was also no evidence that any intervention was effective in increasing HIV-infected infants' identification at 4-8 weeks of age. There is limited evidence to support the hypothesis that interventions implemented to increase uptake of EID were effective at 4-8 weeks of life. Further research is required to identify effective interventions that increase early infant diagnosis of HIV at 4-8 weeks of age. (CRD42020191738).

Point-of-care p24 antigen detection for early infant diagnosis of HIV infection: cross-sectional and longitudinal studies in Zambia

BackgroundEarly infant diagnosis of HIV infection is challenging in sub-Saharan Africa, particularly in rural areas, leading to delays in diagnosis and treatment. Use of a point-of-care test would overcome many challenges. This study evaluated the validity of a novel point-of-care p24 antigen detection test (LYNX) in rural and urban settings in southern Zambia.MethodsTwo studies were conducted: a cross-sectional study from 2014 to 2015 at Macha Hospital (LYNX Hospital study) and a longitudinal study from 2016 to 2018 at 12 health facilities in Southern Province, Zambia (NSEBA study). In both studies, children attending the facilities for early infant diagnosis were enrolled and a blood sample was collected for routine testing at the central lab and immediate on-site testing with the LYNX test. The performance of the LYNX test was measured in comparison to nucleic acid-based testing at the central lab.ResultsIn the LYNX Hospital study, 210 tests were performed at a median age of 23.5 weeks (IQR: 8.9, 29.0). The sensitivity and specificity of the test were 70.0 and 100.0%, respectively. In the NSEBA study, 2608 tests were performed, including 1305 at birth and 1222 on children ≥4 weeks of age. For samples tested at birth, sensitivity was 13.6% (95% CI: 2.9, 34.9) and specificity was 99.6% (95% CI: 99.1, 99.9). While specificity was high for all ages, sensitivity increased with age and was higher for participants tested at ≥4 weeks of age (80.6%; 95% CI: 67.4, 93.7). Children with positive nucleic acid tests were more likely to be negative by the LYNX test if their mother received antiretroviral therapy during pregnancy (60.7% vs. 24.2%; p = 004).ConclusionsConsidering the high specificity and moderate sensitivity that increased with age, the LYNX test could be of value for early infant diagnosis for infants ≥4 weeks of age, particularly in rural areas where centralized testing leads to long delays. Point-of-care tests with moderate sensitivity and high specificity that are affordable, easy-to-use, and easily implemented and maintained should be developed to expand access to testing and deliver same-day results to infants in areas where it is not feasible to implement nucleic acid-based point-of-care assays.

Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study

BackgroundEarly infant diagnosis of HIV infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV DNA testing, leading to delays in diagnosis and treatment initiation. Simple technologies to rapidly deliver results to clinics and notify mothers of test results would decrease many of these delays. The feasibility of using mobile phones to contact mothers was evaluated. In addition, the first two years of implementation of a national short message service (SMS) reporting system to deliver test results from the laboratory to the clinic were evaluated.MethodsThe study was conducted in Macha, Zambia from 2013 to 2015 among mothers of HIV-exposed infants. Mothers were interviewed about mobile phone use and willingness to be contacted directly or through their rural health center. Mothers were contacted according to their preferred method of communication when test results were available. Mothers of positive infants were asked to return to the clinic as soon as possible. Dates of sample collection, delivery of test results to the clinic and notification of mothers were documented in addition to test results.ResultsFour hundred nineteen mothers and infants were enrolled. Only 30% of mothers had ever used a mobile phone. 96% of mobile phone owners were reached by study staff and 98% of mothers without mobile phones were contacted through their rural health center. Turnaround times for mothers of positive infants were approximately 2 weeks shorter than for mothers of negative infants. Delivery of test results by the national SMS system improved from 2013 to 2014, with increases in the availability of texted results (38 vs. 91%) and arrival of the texted result prior to the hardcopy report (27 vs. 83%). Texted results arriving at the clinic before the hardcopy were received a median of 19 days earlier. Four discrepancies between texted and hardcopy results were identified out of 340 tests.ConclusionsMobile phone and text messaging technology has the potential to improve early infant diagnosis but challenges to widespread implementation need to be addressed, including low mobile phone ownership, use and coverage in rural areas.

Early infant diagnosis of HIV infection using DNA-PCR at a referral center: an 8years retrospective analysis.

BackgroundOver the last decade, Ethiopia adopted different strategies of prevention of mother to child transmission of HIV (PMTCT). Prior to implementation of Option A in 2011, there was no provision of prophylaxis for PMTCT. With ‘Option A’, PMTCT interventions relied on maternal CD4 count. In early 2013, ‘‘Option B+’’ has been started; with this option, antiretroviral therapy is started and continued for life to any HIV positive pregnant mother irrespective of CD4 count with an enhanced treatment for the baby. Though there are a number of studies which evaluated the effectiveness of PMTCT interventions, the current study assessed the real-world effectiveness of PMTCT options in a setting where there is limitation of resources.ObjectiveThis study tried to address three questions: what proportion of babies tested by DNA-PCR are HIV infected in the first 2 months of life? How does the type of PMTCT intervention affect presence of HIV infection at this age? What are the factors affecting HIV transmission, after controlling for type of PMCT-HIV intervention?MethodsWe assessed records of 624 registered HIV exposed infants and 412 mothers who were delivered at Bishoftu Hospital from May 2006 to August 2014. Presence of HIV infection at 6–8 weeks of age was assessed from the records. Maternal and infant risk factors for infection at this age were analyzed. Data were collected using standard data abstraction format and were analyzed using SPSS version 20.ResultsAmong all the infants who were delivered at the hospital during the study period, 624/936 (66.7 %) had undergone early infant diagnosis at 6–8 weeks. Twenty-seven (4.3 %) were positive for HIV DNA PCR at the age of 6–8 weeks. None of the infants who received ‘‘Option B+’’ had a positive HIV DNA PCR result. HIV infection rate was highest among those who took either no prophylaxis or single dose Nevirapine (11.5 and 11.1 % respectively). Those who took single dose Nevirapine and Zidovudine had HIV positivity rate of 3.9 %. Many of the covariates which were shown to be predictors on bivariate analysis were found not to be independent predictors on multivariate analysis.ConclusionPMTCT ‘’Option B+’’ resulted in zero HIV infection rates among the included infants. There was a high loss to follow up rate at 6–8 weeks of age. The authors recommend that a better strategy of linkage to care and treatment should be devised for HIV exposed infants.

Utilization of Early Infant Diagnosis of HIV Infection and Associated Factors in Western Ethiopia: Cross-sectional Study

Utilization of Early Infant Diagnosis of HIV Infection and Associated Factors in Western Ethiopia: Cross-sectional Study

Barriers to successful early infant diagnosis of HIV infection at primary care level in Malawi.

HIV-infected women seeking early infant HIV diagnosis (EID) services in Malawi were asked about factors potentially associated with returning for EID results. Many (33.3%) infants failed to complete the EID process because of time and costs required for multiple visits. Infants of mothers receiving antiretroviral treatment were less likely to drop out (adjusted risk ratio 0.51), suggesting that EID completion may improve in programs providing antiretroviral treatment to all pregnant women.

Early infant diagnosis of HIV infection in low-income and middle-income countries: does one size fit all?

Despite expansion of services for prevention of mother-to-child transmission of HIV (PMTCT), about 700 infants acquire HIV every day. Early initiation of antiretroviral therapy for HIV-infected infants reduces mortality but requires diagnosis by virological testing, which is complex, expensive, and inaccessible in many settings. Little cost-effectiveness evidence exists about different strategies to deliver early infant diagnosis services. Cost-effectiveness will vary depending on entry points for testing, underlying prevalences of HIV, PMTCT coverage, treatment availability, programme attrition, and other factors. Appropriate policy responses are therefore context-specific. In most cases, early infant diagnosis should be concentrated at entry points where underlying infant HIV prevalence is highest (eg, malnutrition wards). This strategy contrasts with the tendency at present to test mainly within PMTCT programmes. If testing is undertaken in PMTCT programmes with high coverage, addition of a virological test at birth might have advantages, including greater predictive value, earlier diagnosis, and better infant follow-up. National programme managers should recognise the opportunity costs of the limited resources available, acknowledge the changing scenario of PMTCT scale-up, ensure implementation of provider-initiated testing and counselling, and tailor early infant diagnosis programmes to maximise health gains for children.

Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi

Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi

Dynamics and Constraints of Early Infant Diagnosis of HIV Infection in Rural Kenya

A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolment. Maternal factors associated with infant drop out were maternal loss to follow up (48 [68%] vs. 8 [20%], P < 0.001) and younger maternal age (27.2 vs. 30.1 years, P = 0.033). Service providers and caregivers had inadequate training, knowledge and understanding of EID. Poverty and lack of social support were challenges in accessing EID services. EID should be more closely aligned within PMTCT services, integrated with routine mother and child health (MCH) activities and its implementation more closely monitored.

Early Infant Diagnosis of HIV Infection in Southeastern Nigeria: Prevalence of HIV Infection Among HIV-Exposed Babies

Vertical transmission of HIV-1 is responsible for a high level of infant mortality necessitating early infant diagnosis. Serologic tests are not useful because of persistence of maternal antibodies in infants. Amplification of the integrated viral genome by PCR is the preferred method of diagnosis of HIV infection in these children. To determine the prevalence of HIV among a cohort of HIV-exposed babies. HIV-exposed infants were recruited for DNA PCR (early infant diagnosis). Babies were enrolled from six weeks of age. Relevant data were collected with the aid of a proforma. Mothers were given pre-test counselling. Heel or finger prick samples of blood on Whatman filter paper were used for DNA PCR testing. Data on the initial 304 babies enrolled for DNA PCR were analyzed. Seven (3.6%) of 192 mother-baby pairs who had received requisite prophylactic anti-retrovirals (PARV) were PCR-positive. In 23 (8.7%) PCR positive babies, their mothers received PARV but the babies had no post exposure prophylaxis (PEP), while two (12.5%) of 16 babies who had received PARV without their mothers turned out PCR-positive. Thirty nine (53.4%) of 73 mother-baby pairs who had no PARV were infected. Exclusive breastfeeding (EBF) rate was 35.5%. In these babies five (18.5%) were infected, while 288 (75%) of babies were exclusive formula fed (EFF), out of which 11 (4.8%) were infected. Forty-seven (15.5%) of the babies were mixed-fed, and 32 (68.0%) of them were infected. Prophylactic ARV in mothers and babies gave a marked reduction in Mother-to-Child-Transmission (MTCT) rate. Feeding BMS conferred a superior protection against (MTCT) than EBF.

84 Prematurity in Infants Born to Hiv-Seropositive Mothers

Background: Premature birth occurs in approximately 10% of normal infants. There are limited data regarding the risk of premature delivery and other adverse outcomes of pregnancy in HIV-seropositive women receiving antiretroviral therapy.This study assessed the rate of prematurity in infants born to HIV-seropositive mothers and evaluated whether any relationship may exist between maternal HIV RNA copy number and prematurity. Methods: Maternal viral load, vertical transmission rate and neonatal outcome were prospectively evaluated in a consecutive (1/1/2001–31/12/2003) series of 156 mother-infant pairs followed at the same Institution up to eighteen months from delivery. Gestational age was based on the last menstruation date and confirmed by an ultrasound examination performed within the 20th week. Maternal viral load was determined during the last trimester of pregnancy, using branched DNA and/or NASBA technique. Deliveries at less than 37 weeks were defined as premature. The diagnosis of HIV-infection in infants was based on a positive PCR for HIV in blood obtained at one and three months of life. Variables assessed included ethnicity, drug use antiretroviral therapy during pregnancy and mode of delivery. Results: Out of 156 women, 86% were White, 9% Black, and 5% Hispanic. Eighteen (11.5%) women actively used drugs. Combined therapy during pregnancy was administered in 95% of mothers; six mothers refused any therapy. Most women (98%) underwent caesarean section. Maternal viral load (copy/ml) was: < 1000, 70%; > = 1000, 30%; median (range), 217 (0–370000). Birth weight (g) was: < 1000, 3.8%; 1001–1499, 2.0%; 1500–2499, 21.1%; > = 2500, 73.1%. Premature birth occurred in 29% of infants (95% confidence interval [CI], 26–32%). Only one infant, born at term, whose mother did not receive antiretroviral therapy during pregnancy, was vertically HIV-infected. No significant difference in rate of premature birth was found between infants born to mother having or not viral load > = 1000 copy/ml (75% vs. 68%, odds ratio [95%CI], 1.4 [0.6–3.4]). Conclusion: Within the population studied, the rate of premature birth was markedly high as compared to normal infants. No evident association was found between maternal HIV RNA copy number and prematurity. Supported by AISTMAR