Predictors of Early ART Initiation Among HIV + Infants in Kenya: A Retrospective Review of HITSystem Data from 2013 to 2017

Wexler, Catherine; Nazir, Niaman; Gautney, Brad; Maloba, May; Brown, Melinda; Goggin, Kathy; Lwembe, Raphael; Finocchario-Kessler, Sarah

doi:10.1007/s10995-020-02909-3

Cited by 5 publications

(2 citation statements)

References 27 publications

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“…Ultimately, only an estimated 63% of eligible infants/children are initiated on ART [ 6 ]. Many Kenyan infants diagnosed through EID services are not initiated until 17 weeks, reducing the benefits of very early treatment [ 7 ]. At-birth and point-of-care (POC) HIV testing for infants can streamline infant HIV testing and diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research

Wexler

Kamau

Muchoki

et al. 2021

Implement Sci Commun

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Background At-birth and point-of-care (POC) testing can expedite early infant diagnosis of HIV and improve infant outcomes. Guided by the Consolidated Framework for Implementation Research (CFIR), this study describes the implementation of an at-birth POC testing pilot from the perspective of implementing providers and identifies the factors that might support and hinder the scale up of these promising interventions. Methods We conducted 28 focus group discussions (FGDs) with 48 providers across 4 study sites throughout the course of a pilot study assessing the feasibility and impact of at-birth POC testing. FGDs were audio-recorded, transcribed, and analyzed for a priori themes related to CFIR constructs. This qualitative study was nested within a larger study to pilot and evaluate at-birth and POC HIV testing. Results Out of the 39 CFIR constructs, 30 were addressed in the FGDs. While all five domains were represented, major themes revolved around constructs related to intervention characteristics, inner setting, and outer setting. Regarding intervention characteristics, the advantages of at-birth POC (rapid turnaround time resulting in improved patient management and enhanced patient motivation) were significant enough to encourage provider uptake and enthusiasm. Challenges at the intervention level (machine breakdown, processing errors), inner settings (workload, limited leadership engagement, challenges with access to information), and outer setting (patient-level challenges, limited engagement with outer setting stakeholders) hindered implementation, frustrated providers, and resulted in missed opportunities for testing. Providers discussed how throughout the course of the study adaptations to implementation (improved channels of communication, modified implementation logistics) were made to overcome some of these challenges. To improve implementation, providers cited the need for enhanced training and for greater involvement among stakeholders outside of the implementing team (i.e., other clinicians, hospital administrators and implementing partners, county and national health officials). Despite provider enthusiasm for the intervention, providers felt that the lack of engagement from leadership within the hospital and in the outer setting would preclude sustained implementation outside of a research setting. Conclusion Despite demonstrated feasibility and enthusiasm among implementing providers, the lack of outer setting support makes sustained implementation of at-birth POC testing unlikely at this time. The findings highlight the multi-dimensional aspect of implementation and the need to consider facilitators and barriers within each of the five CFIR domains. Trial registration ClinicalTrials.gov, NCT03435887. Retrospectively registered on 19 February 2020

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Section: Introductionmentioning

confidence: 99%

Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research

Wexler

Kamau

Muchoki

et al. 2021

Implement Sci Commun

Self Cite

View full text Add to dashboard Cite

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“…I n Kenya, there were 6800 pediatric HIV infections in 2019. 1 Many infants are not initiated on antiretroviral therapy (ART) until 4-5.6 months of age, 2,3 well past the peak in mortality at age 2-3 months in infants living with untreated HIV. 4 Studies have shown infant age at ART initiation may be reduced when infant testing is offered at-birth and/or through point-of-care testing (POC) 2,[5][6][7] ; however, in many of these studies, infant age at or time to ART initiation ranged widely (0->180 days).…”

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confidence: 99%

ART Initiation for Infants Diagnosed With HIV Through Point of Care and Conventional Polymerase Chain Reaction Testing in Kenya: A Case Series

Wexler

Maloba

Goggin

et al. 2021

Pediatric Infectious Disease Journal

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We sought to understand the sequence of testing and treatment among nine infants offered both conventional and point-of-care testing and diagnosed as HIV-positive by 6 months of age in Kenya. One infant received per protocol testing and treatment. Patient-level (late presentation and disengagement), provider-level (reluctance and error/oversight) and systemlevel (stock outs, errors) challenges delayed diagnosis and treatment. Early point-of-care testing can streamline testing; however, challenges mitigate benefits.

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A Pilot Study to Evaluate the Impact of the HIV Infant Tracking System (HITSystem 2.0) on Priority Prevention of Mother-to-Child Transmission (PMTCT) Outcomes

Finocchario-Kessler

Brown

Maloba³

et al. 2021

AIDS Behav

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Predictors of Early ART Initiation Among HIV + Infants in Kenya: A Retrospective Review of HITSystem Data from 2013 to 2017

Cited by 5 publications

References 27 publications

Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research

Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research

ART Initiation for Infants Diagnosed With HIV Through Point of Care and Conventional Polymerase Chain Reaction Testing in Kenya: A Case Series

A Pilot Study to Evaluate the Impact of the HIV Infant Tracking System (HITSystem 2.0) on Priority Prevention of Mother-to-Child Transmission (PMTCT) Outcomes

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