Rapid Identification of Infants for Antiretroviral Therapy in a Resource Poor Setting: The Kenya Experience

Abstract

In Kenya, HIV diagnosis is not routinely carried out in infants, and yet rapid diagnosis could improve access to lifesaving interventions. A cheap and readily accessible service can resolve this problem, if feasible. In this pilot study the feasibility and costs of provision of an infant HIV diagnosis service in Kenya are evaluated. Dried blood spots (DBS) were collected from infants exposed to HIV, sent to a central testing laboratory and tested using the Roche Amplicor v. 1.5 DNA PCR kit. The results were then dispatched to health facilities within a week. A total of 15.4% of the samples tested HIV+ despite the widespread access to prevention of mother to child transmission (PMTCT) programs in Kenya. The cost per test at 21.50 USD is prohibitive and will limit access to diagnosis. It remains to be seen whether the increase in testing will immediately lead to an increase in access to antiretroviral therapy (ART) services for infants.

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

“…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] . Establishing an accurate link between rejected samples and the impact on clinical outcome is difficult [32] .…”

“…In the present study the infection rate among accepted samples and repeated samples (9.8% vs 15.9%) is in agreement with previous findings that LTFU can lead to low levels of detection of HIV infection in infants and missed opportunities for care [22,57] . Active patient tracking systems that use social workers to track patients have been applied in Kenya to reduce LTFU among HIV, PMTCT and tuberculosis patients from 21% to 15% [43] . In other studies, peer-based strategies that engage expert and or mentor-mothers in educating and motivating HIV positive mothers to access PMTCT services using their own experience, have been instrumental in improving retention of mother-baby pair in care [58,59] .…”

Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings

“…Finally, results are transmitted back electronically to the health facilities. The centralized structure leads to significant delay (also called turnaround time) between collection of samples and receipt of results at the health facility (Nuwagaba-Biribonwoha et al 2010, Creek et al 2008, Khamadi et al 2008. Long turnaround time (TAT), can adversely impact patient health outcomes because of high mortality rate (Newell et al 2004) and reduced likelihood of collection of results by mothers (or other caregivers) of infants (Latigo-Mugambi et al 2013, NuwagabaBiribonwoha et al 2010, Ciaranello et al 2011, Chatterjee et al 2011.…”

Evaluation of blood collection filter papers for HIV-1 DNA PCR

“…The use of DBS has facilitated the early detection of HIV-1 and subsequent antiretroviral intervention for millions of babies worldwide. [26][27][28][29][30] Qualitative HIV-1 DNA detection has been performed on DBS using commercial and in-house molecular assays, and it is the preferred method for early infant diagnosis of HIV (EID) in RLS. 18,19,[31][32][33][34][35][36][37][38] DBS can be collected heel or finger prick and without the need for venipuncture, stored at RT, and more easily transported to the testing laboratory at RT and with less biohazard risk.…”

“…Therefore, DBS offers several advantages in areas that lack appropriate infrastructure for processing blood and cold-chain for transportation and storage of blood products. [28][29][30]32,33,36 Most HIV-1 DNA testing has been performed on Schleicher & Schuell 903 (or Whatman 903, W-903 (Whatman Inc., Florham Park, NJ, USA)) paper, [5][6][7][8][9][10][11]16,18,19,28,30,31,34,36,38 but limited data are available for other types of blood collection paper, 2,17,27,29,32,35,37 including Ahlstrom grade 226 (ID Biological Systems, Greenville, SC, USA) and Munktell TFN (Munktell Filter AB, Falun, Sweden). These collection papers are manufactured to meet the CLSI (Clinical and Laboratory Standards Institute) standard for Blood Collection on Filter Paper for Newborn Screening programs (LA4-A5, vol.…”