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Point-of-Care Early Infant Diagnosis Improves Adherence to the Testing Algorithm in Kenya
Collins Otieno Odhiambo1, George Githuka2, Nancy Bowen3
1Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Nairobi, Kenya.
Insights
Point-of-care (POC) early infant diagnosis (EID) significantly increased confirmatory testing rates for HIV-infected infants in Kenya. While POC EID shows potential, further improvements are needed for viral load testing adherence.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Early infant diagnosis (EID) of HIV is crucial for timely intervention.
- The revised Kenya EID algorithm aimed to improve diagnostic accuracy and efficiency.
- Point-of-care (POC) testing offers potential for rapid EID results.
Purpose of the Study:
- To evaluate adherence to the revised Kenya EID algorithm.
- To assess the impact of implementing POC EID technology in Kenyan health facilities.
Main Methods:
- Retrospective data collection from national EID database and facility registers (August 2016-July 2018).
- Analysis of 33 health facilities comparing pre- and post-POC EID implementation periods.
- Assessment of confirmatory testing, baseline viral load testing, and follow-up testing rates.
Main Results:
- Confirmatory testing rates significantly increased from 38.6% to 94.2% with POC EID (P < .0001).
- While higher with POC EID, baseline viral load testing and 6-month follow-up testing showed no significant difference compared to the pre-intervention period.
Conclusions:
- POC EID implementation substantially improves the proportion of infants receiving confirmatory HIV testing.
- This increased testing reduces the risk of false-positive results and facilitates prompt management.
- Further optimization of POC EID programs is needed to enhance viral load testing adherence.
Introduction:
We determine the level of adherence to the revised Kenya early infant diagnosis (EID) algorithm during implementation of a point-of-care (POC) EID project.
Methods:
Data before (August 2016 to July 2017) and after (August 2017 to July 2018) introduction of POC EID were collected retrospectively from the national EID database and registers for 33 health facilities. We assessed the number of HIV-infected infants who underwent confirmatory testing and received baseline viral load test and proportion of infants with an initial negative result who had a subsequent test.
Results And Discussion:
Significantly higher number of infants accessed confirmatory testing (94.2% versus 38.6%; P < .0001) with POC EID. Baseline viral load test and follow-up testing at 6 months, although higher with POC EID, were not significantly different from the pre-POC EID intervention period.
Conclusion:
The POC EID implementation has the potential to increase proportion of infants who receive confirmatory testing, thus reducing the risk of false-positive results.
