Worldwide elimination of HIV transmission from mother-to-child is theoretically achievable. In Cambodia, antenatal care (ANC) prevalence has dropped from 1.6% (2003) to 0.71% (2009). However, success in minimizing vertical transmission has been limited by low testing uptake at ANC and delivery. We trained midwives in counselling and performance of an HIV rapid test, incorporated point-of-care testing into routine antenatal and maternity services and determined acceptability, feasibility, accuracy, cost and yield after one year. In all, 97.3% of ANC clients and 73.0% of maternity admissions had unknown HIV status. Testing was offered to 97.6% and 95.0% of untested ANC and maternity clients, respectively. Acceptance rates were 95.5% and 99.4%. Partner testing rate was 38.6%. HIV was diagnosed in 0.1% of ANC clients, 0.4% of partners and 0.9% of women at delivery. For an operational district with an average population of 158,000, point-of-care testing was estimated in one year to identify 19 HIV-infected pregnant women, nine men, 14 discordant couples and 16 exposed infants who otherwise would have not received prophylaxis. Cost was less than $3.75 per person tested. Point-of-care testing during ANC and at delivery is feasible, acceptable and contributes to reducing mother-to-child transmission.

Introduction: The COVID-19 pandemic has impacted global health service delivery, including provision of HIV services. Countries with high HIV burden are balancing the need to minimize interactions with health facilities to reduce the risk of COVID-19 transmission, while delivering uninterrupted essential HIV prevention, testing and treatment services. Many of these adaptations in resource-constrained settings have not adequately accounted for the needs of pregnant and breastfeeding women, infants, children and adolescents. We propose whole-family, tailored programme adaptations along the HIV clinical continuum to protect the programmatic gains made in services. Discussion: Essential HIV case-finding services for pregnant and breastfeeding women and children should be maintained and include maternal testing, diagnostic testing for infants exposed to HIV, index testing for children whose biological parents or siblings are living with HIV, as well as for children/adolescents presenting with symptoms concerning for HIV and comorbidities. HIV self-testing for children two years of age and older should be supported with caregiver and provider education. Adaptations include bundling services in the same visit and providing testing outside of facilities to the extent possible to reduce exposure risk to COVID-19. Virtual platforms can be used to identify vulnerable children at risk of HIV infection, abuse, harm or violence, and link them to necessary clinical and psychosocial support services. HIV treatment service adaptations for families should focus on family based differentiated service delivery models, including community-based ART initiation and multimonth ART dispensing. Viral load monitoring should not be a barrier to transitioning children and adolescents experiencing treatment failure to more effective ART regimens, and viral load monitoring for pregnant and breastfeeding women and children should be prioritized and bundled with other essential services. Conclusions: Protecting pregnant and breastfeeding women, infants, children and adolescents from acquiring SARS-CoV-2 while sustaining essential HIV services is an immense global health challenge. Tailored, family friendly programme adaptations for case-finding, ART delivery and viral load monitoring for these populations have the potential to limit SARS-CoV-2 transmission while ensuring the continuity of life-saving HIV case identification and treatment efforts.

Objective: To describe the implementation and utilization of the Xpert ® MTB/RIF (Xpert) assay to diagnose tuberculosis (TB) among people living with the human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS, PLHA) in Cambodia. Design: Following the rollout of Xpert, an evaluation was conducted in four provinces of Cambodia from March to December 2012 to determine the utilization, performance, and turnaround time (TAT) of Xpert among PLHA. Data were collected from paper-based patient registers. Results: Of 497 PLHA with a positive TB symptom screen, 357 (72%) were tested with smear microscopy, and 250 (50%) with Xpert; 25 (10%) PLHA tested with Xpert were positive for TB and none were rifampicin-resistant. The utilization of Xpert increased from 23% to 75%, with a median TAT of 1 day. Across districts, utilization ranged from zero to 85%, while the TAT ranged from zero to 22 days. Conclusion: While early data show increasing utilization of Xpert for PLHA with a positive symptom screen, most patients underwent smear microscopy as an initial diagnostic test. Training delays and challenges associated with specimen referral may have contributed to variability in Xpert uptake and TAT, particularly for sites without onsite Xpert testing. Enhanced programmatic support, particularly for specimen referral and results reporting, may facilitate appropriate utilization.

Xpert test unit costs could be reduced through lower cartridge prices, longer usable life of GeneXpert (Cepheid, USA) instruments, and increased test volumes; however, epidemiological and test eligibility conditions in Cambodia limit the number of specimens received at laboratories, leading to sub-optimal utilization of current instruments. Improvements to patient referral and specimen transport could increase test volumes and reduce Xpert test unit costs in this setting.

This PDF document was made available from www.rti.org as a public service of RTI International. More information about RTI Press can be found at http://www.rti.org/rtipress. RTI International is an independent, nonprofit research organization dedicated to improving the human condition by turning knowledge into practice. The RTI Press mission is to disseminate information about RTI research, analytic tools, and technical expertise to a national and international audience. RTI Press publications are peer-reviewed by at least two independent substantive experts and one or more Press editors. Suggested CitationDarcy, N., Kelley, C., Reynolds, E., Cressman, G., and Killam, P. (2010 All rights reserved. Please note that this document is copyrighted and credit must be provided to the authors and source of the document when you quote from it. You must not sell the document or make a profit from reproducing it. AbstractElectronic medical records (EMRs) present a multitude of potential benefits for health systems, especially those in low-income developing countries. For instance, EMR systems can improve patient care by allowing medical personnel to access patients' records throughout the geographic area; they can increase medical personnel's efficiency by reducing the time required for data management and record keeping. Benefits for the overall health care system include easier collection of data for surveillance and rich data sets for further health research. Successful implementation means facing significant challenges, however, including a lack of human capital, low levels of physical and material resources, and low use once the system is implemented. This report advocates deployment of an electronic patient referral system as a reasonable first step in deploying a complete EMR system, because implementers of the smaller system can address and overcome many of the obstacles that full EMR systems commonly face. The report discusses the participatory and user-driven design, implementation, and results of an installed electronic perinatal patientreferral system supporting health personnel who referred patients through a closed-network, Web-based system in the Lusaka health district in Zambia. It demonstrates how the patient referral module laid the groundwork for a larger EMR system.