High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs

Wagner, Anjuli D.; Slyker, Jennifer A.; Langat, Agnes; Inwani, Irene; Adhiambo, Judith; Benki-Nugent, Sarah; Tapia, Ken; Njuguna, Irene; Wamalwa, Dalton; John‐Stewart, Grace

doi:10.1186/s12887-015-0325-8

Cited by 43 publications

(36 citation statements)

References 23 publications

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“…Linkage to care commences with identification of exposed infants. Delays in accessing testing and antiretroviral treatment can result in a three times higher mortality [16]. In South Africa, 6-week immunization uptake is 96% when EID is offered [17].…”

Section: Key Pointsmentioning

confidence: 99%

An update on the HIV treatment cascade in children and adolescents

Bobat

Archary²,

Lawler³

2015

Current Opinion in HIV and AIDS

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Section: Key Pointsmentioning

confidence: 99%

An update on the HIV treatment cascade in children and adolescents

Bobat

Archary²,

Lawler³

2015

Current Opinion in HIV and AIDS

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“…4,5 Improving early diagnostic and ART coverage is challenging and may be strengthened by innovative approaches like Point of Care Testing (POCT). 6,7 …”

Section: Introductionmentioning

confidence: 99%

Xpert HIV-1 point-of-care test for neonatal diagnosis of HIV in the birth testing programme of a maternity hospital: a field evaluation study

et al. 2017

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Summary Background Performance of Point-of-Care testing (POCT) amongst HIV-exposed infants, compared to laboratory-based testing (LABT), may improve linkage to care. We present a field evaluation of HIV-1 POCT at birth in the context of universal LABT in a maternity hospital in Johannesburg, South Africa and describe our implementation experience. Methods We conducted our field evaluation study between October 2014–April 2016 at an urban public delivery facility. We aimed to sample consecutive neonates at birth for POCT (Cepheid Xpert® HIV-1 Qualitative test) and compared results to LABT (Roche COBAS® TaqMan® HIV-1 Qualitative test) with respect to performance (sensitivity, specificity, positive and negative predictive value [PPV and NPV] and Cohen’s kappa coefficient), result return, antiretroviral treatment (ART) initiation and coverage. Findings Amongst 3970 infants with LABT, 57 (1.4%) tested positive, 3906 (98.5%) negative, 2 (0.1%) indeterminate, and 5 (0.1%) had an error result. 2238 (56.4%) of these infants had concurrent POCT. POCT detected all 30 HIV-infected neonates (sensitivity 100%; 95% CI: 88.4–100%) with two additional false positive results (specificity 99.9%; 95% CI: 99.7–100%). All positive and 96.2% of negative POCT results were returned compared with 88.9% of positive and 52.8% of negative LABT results. While each POCT required 90 minutes of instrument time, 2.6 hours (IQR: 2.3–3.1) elapsed between phlebotomy and result return. In days, median time of result return for POCT was one day, significantly earlier than ten days for LABT (p<0.0001). Antiretroviral treatment was initiated in 30 (100%) neonates with positive POCT compared to 24 (88.9%, p=0.10) of 27 infants who had LABT only, with initiation occurring a median of 5 days earlier in the POCT group (p<0.0001). POCT implementation required additional staff and weekend cover. Interpretation Compared to LABT, POCT was associated with excellent performance, improved rates of result return and reduced time to ART initiation. Resources needed to integrate POCT into a routine birth testing program require further evaluation. Funding The study was supported in part by the National Institutes of Health U01 HD080441 and USAID/PEPfAR.

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“…Untreated pediatric HIV has an aggressive course with high mortality [1-6]. While systems to diagnose infant HIV are improving, many older children remain undiagnosed [7].…”

Section: Introductionmentioning

confidence: 99%

Brief Report: Disclosure, Consent, Opportunity Costs, and Inaccurate Risk Assessment Deter Pediatric HIV Testing: A Mixed-Methods Study

Wagner

O’Malley

Firdawsi

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Prompt child HIV testing and treatment is critical; however, children are often not diagnosed until symptomatic. Understanding factors that influence pediatric HIV testing can inform strategies to increase testing. Methods A mixed-methods study was conducted at a tertiary hospital in Nairobi, Kenya. Three focus group discussions with health care workers (HCW) and 18 in-depth interviews with HIV-infected adults with children of unknown status were analyzed using thematic analysis. A structured questionnaire was administered to 116 HIV-infected caregivers of children of unknown status to triangulate qualitative findings. Results Analysis revealed 3 key periods of the pediatric HIV testing process: decision to test, test visit, and post-test. Key issues included: decision to test: inaccurate HIV risk perception for children, challenges with paternal consent, lack of caregiver HIV status disclosure to partners/older children; test experience: poor understanding of child consent/assent and disclosure guidelines, perceived costs of testing and care, school schedules, HCW discomfort with pediatric HIV testing; post-test: pessimism regarding HIV-infected children’s prognosis, caregiver concerns about own emotional health if child is positive, and challenges communicating about HIV with children. Concerns about all three periods influenced child testing decisions. Additionally, three challenges were unique to pediatric HIV: inaccurate HIV risk perception for children; disclosure, consent, and permission; and costs and scheduling. Conclusions Pediatric HIV testing barriers are distinct from adult barriers. Uptake of pediatric HIV testing may be enhanced by interventions to address misconceptions, disclosure services, psychosocial support addressing concerns unique to pediatric testing, child-focused HCW training, and alternative clinic hours.

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High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs

Cited by 43 publications

References 23 publications

An update on the HIV treatment cascade in children and adolescents

An update on the HIV treatment cascade in children and adolescents

Xpert HIV-1 point-of-care test for neonatal diagnosis of HIV in the birth testing programme of a maternity hospital: a field evaluation study

Brief Report: Disclosure, Consent, Opportunity Costs, and Inaccurate Risk Assessment Deter Pediatric HIV Testing: A Mixed-Methods Study

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