Same‐day test and treat for infants with HIV infection: finally within reach

Vojnov, Lara; Havlir, Diane V.; Myer, Landon; Abrams, Elaine J.; Jani, Ilesh

doi:10.1002/jia2.26016

Cited by 4 publications

(1 citation statement)

References 6 publications

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“…As a first step in the depth of surgical coverage, focus should be put on defining an essential and basic emergency surgical package [64]. Incorporating this essential surgical package into existing healthcare packages, such as maternal and child health plans or HIV test-and-treat programs, can build upon the progress already made in these sectors in LMICs [65][66][67]. Particular attention must be put on surgical procedures that avert a significant portion of the health burden in the pediatric population.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Modeling the global impact of reducing out-of-pocket costs for children’s surgical care

Smith,

Espinoza,

Metcalf

et al. 2024

PLOS Glob Public Health

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Over 1.7 billion children lack access to surgical care, mostly in low- and middle-income countries (LMICs), with substantial risks of catastrophic health expenditures (CHE) and impoverishment. Increasing interest in reducing out-of-pocket (OOP) expenditures as a tool to reduce the rate of poverty is growing. However, the impact of reducing OOP expenditures on CHE remains poorly understood. The purpose of this study was to estimate the global impact of reducing OOP expenditures for pediatric surgical care on the risk of CHE within and between countries. Our goal was to estimate the impact of reducing OOP expenditures for surgical care in children for 149 countries by modeling the risk of CHE under various scale-up scenarios using publicly available World Bank data. Scenarios included reducing OOP expenditures from baseline levels to paying 70%, 50%, 30%, and 10% of OOP expenditures. We also compared the impact of these reductions across income quintiles (poorest, poor, middle, rich, richest) and differences by country income level (low-income, lower-middle-income, upper-middle-income, and high-income countries).Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal. The risk of CHE due to a surgical procedure for children was highest in low-income countries. An unexpected observation was that upper-middle income countries were at higher risk for CHE than LMICs. The most vulnerable regions were Africa and Latin America. Across all countries, the poorest quintile had the greatest risk for CHE. Increasing interest in financial protection programs to reduce OOP expenditures is growing in many areas of global health. Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal across countries, wealth groups, or even by wealth groups within countries. Understanding these complexities is critical to develop appropriate policies to minimize the risks of poverty.

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Section: Plos Global Public Healthmentioning

confidence: 99%

Modeling the global impact of reducing out-of-pocket costs for children’s surgical care

Smith,

Espinoza,

Metcalf

et al. 2024

PLOS Glob Public Health

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Point-of-care testing to achieve paediatric 95-95-95 targets

Peter¹,

Jani²

2023

The Lancet HIV

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Impact of Point-of-Care Birth Test-and-Treat on Clinical Outcomes Among Infants With Human Immunodeficiency Virus: A Cluster-Randomized Trial in Mozambique and Tanzania

Jani,

Sabi,

Elsbernd

et al. 2024

Clinical Infectious Diseases

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Background We assessed the impact of point-of-care (PoC) test-and-treat at birth on clinical outcomes and viral suppression among HIV-positive infants in Mozambique and Tanzania. Methods This cluster-randomized trial allocated health facilities to intervention, providing PoC-testing and antiretroviral treatment (ART) at birth and week 4-8, or control, starting these at week 4-8. The primary outcome was proportions of clinical events (mortality, morbidity, retention, virological failure, toxicity) among HIV-positive infants at month-18. We estimated incidence rate ratios adjusted for timing of HIV-detection (aIRR) and reported viral suppression <1000 copies/mL. Findings Among 6602 neonates enrolled October 2019-September 2021, 125 were diagnosed HIV-positive by week 12. In the intervention arm, 38/69 (55.1%) were diagnosed at birth with 35 initiating ART within two days. In the control arm, 27/56 (48.2%) were retrospectively detected HIV-positive at birth, of whom 6/56 (10.7%) died or were lost to follow-up before testing. Median age at ART initiation was 6 (intervention) versus 33 days (control). Birth test-and-treat was not associated with a significant reduction in clinical outcomes up to month-18 [53 (76.8%) versus 48 (85.7%); aIRR 0.857; 95% CI 0.505–1.492], but showed a 68% relative reduction in 6-month mortality. Viral suppression was poor overall, but improved in the intervention group at month 18 (65.7% versus 29.6%; p=0.005). Interpretation PoC test-and-treat at birth is feasible in resource-poor settings and resulted in clinically-relevant reduction of early infant mortality, though improved clinical outcomes were not sustained to month-18. Poor viral suppression may undermine early survival benefits, calling for better paediatric treatments and tailored adherence interventions.

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Same‐day test and treat for infants with HIV infection: finally within reach

Cited by 4 publications

References 6 publications

Modeling the global impact of reducing out-of-pocket costs for children’s surgical care

Modeling the global impact of reducing out-of-pocket costs for children’s surgical care

Point-of-care testing to achieve paediatric 95-95-95 targets

Impact of Point-of-Care Birth Test-and-Treat on Clinical Outcomes Among Infants With Human Immunodeficiency Virus: A Cluster-Randomized Trial in Mozambique and Tanzania

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