Feasibility of Early Infant Diagnosis of HIV in Resource-Limited Settings: The ANRS 12140-PEDIACAM Study in Cameroon

Tejiokem, Mathurin Cyrille; Faye, Albert; Penda, Calixte Ida; Guemkam, Georgette; Ndongo, Francis Atéba; Chewa, Gisele; Rekacewicz, Claire; Rousset, Dominique; Kfutwah, Anfumbom; Boisier, P.; Warszawski, Josiane

doi:10.1371/journal.pone.0021840

Cited by 57 publications

(51 citation statements)

References 21 publications

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“…The median time between blood draw for DBS to result recipient by the respective health facility was 36 days (IQR: 25 -49 days). These findings are consistent with other studies from Kenya and Mozambique [8] [17] [18] but lower than study report from Cameroon and Malawi [9] [19].…”

Section: Discussionsupporting

confidence: 92%

Delay in Early Infant Diagnosis and High Loss to Follow-Up among Infant Born to HIV-Infected Women in Ethiopia

Kebede¹,

Gebeyehu²,

Jain³

et al. 2014

WJA

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Background: Many HIV-infected infants and children die from HIV related causes without their HIV status being known or receiving HIV care. All HIV exposed infants should be tested by Dried Blood Spots (DBS)-PCR before or at 6 weeks of age. Testing is a crucial step to facilitate early access to antiretroviral treatment (ART). However, studies that assess the level of use and implementation of HIV DNA testing in Ethiopia are lacking. Objective: To investigate the rate of early infant diagnosis (EID), defined as having blood drawn for HIV DNA-PCR testing, and predictive factors of EID among infants born to HIV infected women. Method: A multicentre retrospective cohort study was conducted from April to June 2012 in three public hospitals and three health centers, in Northwest Ethiopia. Mother-infant pairs were followed from delivery until the time of the HIV diagnostic test. Data were captured using standardized forms. The time-to-diagnostic test was estimated using Kaplan-Meier estimators. Factors associated with EID were evaluated using logistic regression. Result: Of the 266 HIV-exposed infants identified from the health facilities, only 109 (41.0%) infants had early HIV DNA-PCR tests. The median age at the time of HIV diagnostic testing was 60 days (95% CI: 47 -73 days), and the median turnaround time between blood draw for DNA-PCR testing to delivery of a test result to the respective health facility was 36 days (95% CI: 33 -40 days). A total of 35 (13.2%) infants were diagnosed with HIV infection. The predictors of EID were the mother having prenatal care, maternal receipt of ART during pregnancy and place of birth. Conclusion: Three out of five HIV-infected women did not bring their infant for HIV testing during the recommended 6 week interval after birth. Special attention is required for infants born to HIV-infected women who did not

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Section: Discussionsupporting

confidence: 92%

Delay in Early Infant Diagnosis and High Loss to Follow-Up among Infant Born to HIV-Infected Women in Ethiopia

Kebede¹,

Gebeyehu²,

Jain³

et al. 2014

WJA

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“…Predictors for early infant diagnosis were reported in three studies [26-28]. These showed positive associations between uptake of testing and proximity to the clinic [26], large family size [26], early HIV diagnosis of the mother [27], or having received antiretroviral prophylaxis for PMTCT [27] (webappendix Table S2). The combined estimate of the percentage of infants tested between 12 and 18 months postpartum based on 7 studies was 55.2% with 95% CI 36.4-74.1% and Prl 0.0-100.0% (Figure 4, webappendix Table S3).…”

Section: Resultsmentioning

confidence: 99%

Missed opportunities to prevent mother-to-child-transmission

Wettstein

Mugglin

Egger

et al. 2012

Aids

158

131

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Objectives To determine magnitude and reasons of loss to programme and poor antiretroviral prophylaxis coverage in prevention of mother-to-child transmission (PMTCT) programmes in sub-Saharan Africa. Design Systematic review and meta-analysis. Methods We searched PubMed and Embase databases for PMTCT studies in sub-Saharan Africa published between January 2002 and March 2012. Outcomes were the percentage of pregnant women (i) tested for HIV, (ii) initiating antiretroviral prophylaxis, (iii) having a CD4 cell count measured, and (iv) initiating antiretroviral combination therapy (cART) if eligible. In children outcomes were (v) early infant diagnosis for HIV, and (vi) cART initiation. We combined data using random-effects meta-analysis and identified predictors of uptake of interventions. Results Forty-four studies from 15 countries including 75,172 HIV-infected pregnant women were analyzed. HIV-testing uptake at antenatal care services was 94% (95% confidence intervals [CI] 92-95%) for opt-out and 58% (95% CI 40-75%) for opt-in testing. Coverage with any antiretroviral prophylaxis was 70% (95% CI 64-76%) and 62% (95% CI 50-73%) of pregnant women eligible for cART received treatment. Sixty-four percent (95% CI 48-81%) of HIV exposed infants had early diagnosis performed and 55% (95% CI 36-74%) were tested between 12 and 18 months. Uptake of PMTCT interventions was improved if cART was provided at the antenatal clinic and if the male partner was involved. Conclusions In sub-Saharan Africa, uptake of PMTCT interventions and early infant diagnosis is unsatisfactory. An integrated family-centered approach seems to improve retention.

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“…22 A larger study that included 1,587 HIV-exposed infants in Cameroon examined the association between multiple predictors and having an incomplete EID process by seven months found that women who received no prophylaxis (OR: 2.3 [95% CL: 1.2-4.1]) or short-course prophylaxis (OR: 1.4 [95% CL: 0.9-2.1]) were more likely to have an incomplete EID process compared to women who received cART. 23 …”

Section: Discussionmentioning

confidence: 99%

Implementation and Operational Research

Feinstein

Edmonds

Okitolonda

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Programs to prevent mother-to-child HIV transmission (PMTCT) are plagued by loss to follow-up (LTFU) of HIV-exposed infants. We assessed if providing combination antiretroviral therapy (cART) to HIV-infected mothers was associated with reduced LTFU of their HIV-exposed infants in Kinshasa, DR Congo. Methods We constructed a cohort of mother-infant pairs using routinely collected clinical data. Maternal cART eligibility was based on national guidelines in effect at the time. Infants were considered LTFU following three failed tracking attempts after a missed visit or if more than six months passed since they were last seen in clinic. Statistical methods accounted for competing risks (e.g. death). Results 1318 infants enrolled at a median age of 2.6 weeks (interquartile range [IQR]: 2.1-6.9), at which point 24% of mothers were receiving cART. Overall, 5% of infants never returned to care following enrollment and 18% were LTFU by 18 months. The 18-month cumulative incidence of LTFU was 8% among infants whose mothers initiated cART by infant enrollment and 20% among infants whose mothers were not yet on cART. Adjusted for baseline factors, infants whose mothers were not on cART were over twice as likely to be LTFU, with a subdistribution hazard ratio of 2.75 (95% confidence limit: 1.81, 4.16). The association remained strong regardless of maternal CD4 count at infant enrollment. Conclusion Increasing access to cART for pregnant women could improve retention of HIV-exposed infants, thereby increasing the clinical and population-level impacts of PMTCT interventions and access to early cART for HIV-infected infants.

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Feasibility of Early Infant Diagnosis of HIV in Resource-Limited Settings: The ANRS 12140-PEDIACAM Study in Cameroon

Cited by 57 publications

References 21 publications

Delay in Early Infant Diagnosis and High Loss to Follow-Up among Infant Born to HIV-Infected Women in Ethiopia

Delay in Early Infant Diagnosis and High Loss to Follow-Up among Infant Born to HIV-Infected Women in Ethiopia

Missed opportunities to prevent mother-to-child-transmission

Implementation and Operational Research

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