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Published on: October 31, 2010
Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania
Harriet Nuwagaba-Biribonwoha1, Bazghina Werq-Semo, Aziz Abdallah
1Columbia University, International Centre for AIDS Care and Treatment Programs ICAP, Dar es salaam, Tanzania.
Insights
This pilot program successfully introduced early infant diagnosis (EID) using HIV DNA Polymerase Chain Reaction (PCR) testing in Tanzania. Despite challenges with result return, the program informed national EID rollout.
Area of Science:
- Public Health
- Virology
- Pediatrics
Background:
- Less than a third of HIV-infected children in Tanzania receive antiretroviral therapy (ART).
- Diagnosing HIV in infants is complex due to overlapping symptoms with other infections and malnutrition.
- An Early Infant Diagnosis (EID) pilot program was initiated to improve national access to testing.
Purpose of the Study:
- To introduce and evaluate an EID pilot program utilizing HIV DNA Polymerase Chain Reaction (PCR) testing.
- To gather lessons learned for a potential national EID program rollout in Tanzania.
Main Methods:
- Established a molecular biology laboratory for HIV DNA PCR testing on Dried Blood Spots (DBS).
- Trained 96 health workers across 4 facilities on HIV-exposed infant identification, care, and DBS collection.
- Implemented paper-based tracking systems linked to an electronic database for program monitoring.
Main Results:
- 510 HIV-exposed infants were identified; 441 (87%) received HIV DNA PCR testing.
- 17% of tested infants were PCR positive for HIV.
- Only 55% of parents/guardians returned to receive PCR test results, with lower return rates for negative results.
Conclusions:
- The EID pilot program successfully established systems for identifying and testing HIV-exposed infants.
- High infant registration and testing rates were observed during the 6-month pilot.
- Parental return for test results remains a significant challenge, informing strategies for the national EID program.
Background:
In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without specialized virologic testing can be a complex process. We aimed to introduce an Early Infant Diagnosis (EID) pilot program using HIV DNA Polymerase Chain Reaction (PCR) testing with the intent of making EID nationally available based on lessons learned in the first 6 months of implementation.
Methods:
In September 2006, a molecular biology laboratory at Bugando Medical Center was established in order to perform HIV DNA PCR testing using Dried Blood Spots (DBS). Ninety-six health workers from 4 health facilities were trained in the identification and care of HIV-exposed infants, HIV testing algorithms and collection of DBS samples. Paper-based tracking systems for monitoring the program that fed into a simple electronic database were introduced at the sites and in the laboratory. Time from birth to first HIV DNA PCR testing and to receipt of test results were assessed using Kaplan-Meier curves.
Results:
From October 2006 to March 2007, 510 HIV-exposed infants were identified from the 4 health facilities. Of these, 441(87%) infants had an HIV DNA PCR test at a median age of 4 months (IQR 1 to 8 months) and 75(17%) were PCR positive. Parents/guardians for a total of 242(55%) HIV-exposed infants returned to receive PCR test results, including 51/75 (68%) of those PCR positive, 187/361 (52%) of the PCR negative, and 4/5 (80%) of those with indeterminate PCR results. The median time between blood draw for PCR testing and receipt of test results by the parent or guardian was 5 weeks (range <1 week to 14 weeks) among children who tested PCR positive and 10 weeks (range <1 week to 21 weeks) for those that tested PCR negative.
Conclusions:
The EID pilot program successfully introduced systems for identification of HIV-exposed infants. There was a high response as hundreds of HIV-exposed infants were registered and tested in a 6 month period. Challenges included the large proportion of parents not returning for PCR test results. Experience from the pilot phase has informed the national roll-out of the EID program currently underway in Tanzania.
