Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Early infant diagnosis (EID) and treatment are crucial for reducing early infant mortality.
• Very early infant diagnosis (VEID) aims to test infants within two weeks of life.
• Existing EID systems face challenges with specimen transport and result turnaround times.

Purpose of the Study:

• To evaluate the turnaround time (TAT) for HIV test results and ART initiation in infants.
• To compare TAT with and without the availability of birth testing.
• To assess the impact of VEID on early diagnosis and treatment initiation.

Main Methods:

• Observational prospective cohort study involving 12 VEID facilities and 10 non-cohort facilities.
• Data collected from facility records and national databases for HIV-exposed infants born in January-June 2016.
• Analysis of TAT from blood draw to caregiver result receipt and ART initiation timing.

Main Results:

• Median TAT from blood draw to result receipt was 76.5 days for birth testing and 63-70 days for six-week testing.
• Infants tested at birth received results about one month earlier than those tested at six weeks.
• Infants diagnosed at birth initiated ART approximately two months earlier (median 6.4 weeks) than those diagnosed at six weeks (median 14.8 weeks).

Conclusions:

• While VEID can lead to earlier diagnosis and ART initiation, current prolonged TATs pose a significant challenge.
• The effectiveness of VEID may be compromised by delays in specimen transport and result return within existing EID systems.
• Improvements in laboratory and logistics infrastructure are needed to optimize VEID program outcomes.