If you text them, they will come

Abstract

Objective The objective of this study is to evaluate the impact of the HIV Infant Tracking System (HITSystem) for quality improvement of early infant diagnosis (EID) of HIV services. Design and Setting This observational pilot study compared 12 months of historical preintervention EID outcomes at one urban and one peri-urban government hospital in Kenya to 12 months of intervention data to assess retention and time throughout the EID cascade of care. Participants Mother–infant pairs enrolled in EID at participating hospitals before (n = 320) and during (n = 523) the HITSystem pilot were eligible to participate. Intervention The HITSystem utilizes Internet-based coordination of the multistep PCR cycle, automated alerts to trigger prompt action from providers and laboratory technicians, and text messaging to notify mothers when results are ready or additional action is needed. Main outcome measures The main outcome measures were retention throughout EID services, meeting time-sensitive targets and improving results turn-around time, and increasing early antiretroviral therapy (ART) initiation among HIV-infected infants. Results The HITSystem was associated with an increase in the proportion of HIV-exposed infants retained in EID care at 9 months postnatal (45.1–93.0% urban; 43.2–94.1% peri-urban), a decrease in turn-around times between sample collection, PCR results and notification of mothers in both settings, and a significant increase in the proportion of HIV-infected infants started on antiretroviral therapy at each hospital(14 vs. 100% urban; 64 vs. 100% peri-urban). Conclusion The HITSystem maximizes the use of easily accessible technology to improve the quality and efficiency of EID services in resource-limited settings.

Barriers, facilitators and recommendations for the early infant diagnosis and treatment (EIDT) cascade: A qualitative study in Malawi

“…[12] Sample processing and transport (step 3) results indicate the need for the establishment of a strong sample transport system and a laboratory information system possibly using SMS. [13] In addition, having procedures that work for after-hours sample delivery and for reporting of results would address barriers. Another study encourages initiation with point-of-care testing as the best solution to avoid issues of sample transport and hence fast delivery of results.…”

Cross-subtype detection of HIV-1 using reverse transcription and recombinase polymerase amplification

“…This typically results in large delays in reporting of test results to caregivers, delaying treatment initiation. While some logistical challenges can be addressed to improve turnaround time for infant HIV diagnosis (Finocchario-Kessler et al, 2014;Ghadrshenas et al, 2013;Kiyaga et al, 2013), an alternative solution is to simplify the diagnostics to enable testing at the point of care.…”

Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances

“…Substantial attention has been given to cell phone-based interventions to improve retention among mothers and children. A trial in Kenya evaluated the HITSystem, an Internetbased system designed to increase patient retention for early infant diagnosis (EID) of HIV infection [20]. This system integrated automated SMS within the Kenyan EID cascade.…”