A Proposed Framework for the Implementation of Early Infant Diagnosis Point-of-Care

Abstract

Early diagnosis of HIV infection in infants and children remains a challenge in resource-limited settings, with approximately half of all HIV-exposed infants receiving virological testing for HIV by the recommended age of 2 months in 2015. To reduce morbidity and mortality among HIV-infected children and close the treatment gap for HIV-infected children, there is an urgent need to evaluate existing programmatic and laboratory practices for early infant diagnosis and introduce strategies to improve identification of HIV-exposed infants and ensure access to systematic, early HIV testing, with early linkage to treatment for HIV-infected infants. This article describes progress made in follow-up of HIV-exposed infants since 2006, including remaining unmet laboratory and programmatic needs, and recommends strategies for improvement, especially those related to the implementation of point-of-care technology for early infant diagnosis.

Field Evaluation of Performance of Alere and Cepheid Qualitative HIV Assays for Pediatric Point-of-Care Testing in an Academic Hospital in Soweto, South Africa

“…EID point-of-care (POC) technologies were developed to facilitate early diagnoses and are now commercially available. These are attractive tools that have the potential to overcome logistical challenges (9,10). EID POC devices, operated by nontechnical staff and without laboratory infrastructure, can provide HIV test results in less than 2 h in a clinic, enabling same-day result receipt and linkage to care (11).…”

Assessment of the Early Infant Diagnosis of HIV Infection in Togo in 2014

“…In Uganda, nearly one third of mother-baby pairs are not retained in HIV care: lack of EID services, poor quality service, non-disclosure of mother's HIV status and understanding the importance of adhering to all appointments together with the baby, were associated with time to non-retention [6]. EID is one of the strategies to achieve UNAIDS (Joint United Nations Programme on HIV/AIDS) goals 90-90-90 (by 2020, 90% of all people living with HIV will know their status, 90% of all people diagnosed with HIV will receive a supported antiretroviral therapy (ART) and 90% of all people receiving ART will have a lasting viral suppression); however, country data for this indicator are fragmented or non-existent [7][8][9][10]. Infants infected with HIV during pregnancy, childbirth or premature deliveries often die before their HIV status is known.…”

“…These authors recommend updating guidelines for use of rapid tests in young HIVexposed children that explicitly take type of test and infant age in a context where PCR is not very accessible [17]. Innovative strategies need to be implemented, particularly those related to the implementation of Point-of-Care (PoC) technology for EID [5,9,11]. Despite its lower sensitivity, the PoC test had the potential to provide test results to up to 81% more patients compared to the laboratory-based test [9,18] and may be useful in peripheral care environment [18].…”

“…Innovative strategies need to be implemented, particularly those related to the implementation of Point-of-Care (PoC) technology for EID [5,9,11]. Despite its lower sensitivity, the PoC test had the potential to provide test results to up to 81% more patients compared to the laboratory-based test [9,18] and may be useful in peripheral care environment [18]. The DBS can be used as an affordable tool to monitor the accuracy of PoC tests and be practical for quality control programs.…”

Evidence of accessibility and utility of point-of-care diagnostics as an integral part of prevention of mother-to-child transmission services: systematic scoping review protocol

“… 7 25 POC testing fits into the infant HIV continuum of care by facilitating early diagnosis, enrolment into care and reducing loss to follow-up to ensure chances of child survival. 26 POC testing is also useful in detecting asymptomatic malaria and GBS infections, which can be transmitted vertically during the gestational period. 13 27 28 …”