Improved access to early infant diagnosis is a critical part of a child-centric prevention of mother-to-child transmission agenda

Abstract

Programs focused on preventing vertical transmission need to increase their commitment to child-centric interventions and broaden their measure of success to reflect infants who test negative at the end of the exposure period. This paper argues that EID is a key strategy to retaining HIV-exposed infants through the end of the exposure period, as it provides an opportunity to offer early clinical care and continuous follow up. It is imperative that maternal and child survival programs become sensitized to the urgency of early identification of HIV in infants and their retention in care.

Correlates of Suboptimal Entry Into Early Infant Diagnosis in Rural North Central Nigeria

“…Busy clinical facilities and staffing constraints are established factors that could hinder quality of follow-up care for HIV-exposed infants. 8,31 Third, the first mothers to engage HIV-care may have been motivated more than later mothers who were brought into care, affecting the return rate for EID in their newborns.…”

“…2 EID coverage was even worse in SSA, where 6 of 31 countries reported EID testing rates below 10%, resulting in millions of undiagnosed HIV-exposed infants. 2,8 ART coverage among HIV-infected children in 2012 was also approximately half the coverage for adults (34% vs. 64%, respectively). 2 …”

Active tracking of rejected dried blood samples in a large program in Nigeria

“…Delay in presentation for EID averts the opportunities to administer ARV and reduce MTCT [6,7,39] , thereby permitting the emergence of more severe clinical manifestation of HIV infection in pediatric patients [40] . Strategies that enhance awareness of PMTCT and EID services, promote partner involvement, provide economic incentives and offer close follow-up to HIV positive women during pregnancy and after delivery have been shown to be effective [41,42] . Active tracking of HIV positive mothers using support groups and mobile applications have also been shown to increase uptake of services and retention of the mother-baby pair in PMTCT programs [41,43,44] .…”

HIV and the Millennium Development Goals

“…Diagnosis in young children, therefore, requires nucleic acid testing, which is approximately 10-fold more expensive, technically demanding and inaccessible in many settings. EID, together with initiation of cotrimoxazole prophylaxis for all HIV-exposed infants, is recommended at 4–6 weeks of age, or at the earliest opportunity thereafter20 (although there is an emerging argument for moving the first virological test closer to birth24 25). EID coverage has expanded substantially over the last 5 years, but in 2013, only 44% of all HIV-exposed infants received a test before 2 months of age.…”