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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Implementing services for early infant diagnosis (EID) of HIV: A comparative descriptive analysis of national programs in four countries
BMC Public Health, Volume 11, Article 553, Year 2011
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Description
Background: There is a significant increase in survival for HIV-infected children who have early access to diagnosis and treatment. The goal of this multi-country review was to examine when and where HIV-exposed infants and children are being diagnosed, and whether the EID service is being maximally utilized to improve health outcomes for HIV-exposed children. Methods. In four countries across Africa and Asia existing documents and data were reviewed and key informant interviews were conducted. EID testing data was gathered from the central testing laboratories and was then complemented by health facility level data extraction which took place using a standardized and validated questionnaire. Results: In the four countries reviewed from 2006 to 2009 EID sample volumes rose dramatically to an average of >100 samples per quarter in Cambodia and Senegal, >7,000 samples per quarter in Uganda, and >2,000 samples per quarter in Namibia. Geographic coverage of sites also rapidly expanded to 525 sites in Uganda, 205 in Namibia, 48 in Senegal, and 26 in Cambodia in 2009. However, only a small proportion of testing was done at lower-level health facilities: in Uganda Health Center IIs and IIIs comprised 47% of the EID collection sites, but only 11% of the total tests, and in Namibia 15% of EID sites collected >93% of all samples. In all countries except for Namibia, more than 50% of the EID testing was done after 2 months of age. Few sites had robust referral mechanisms between EID and ART. In a sub-sample of children, we noted significant attrition of infants along the continuum of care post testing. Only 22% (Senegal), 37% (Uganda), and 38% (Cambodia) of infants testing positive by PCR were subsequently initiated onto treatment. In Namibia, which had almost universal EID coverage, more than 70% of PCR-positive infants initiated ART in 2008. Conclusions: While EID testing has expanded dramatically, a large proportion of PCR- positive infants are initiated on treatment. As EID services continue to scale-up, more programmatic attention and support is needed to retain HIV-exposed infants in care and ensure that those testing positive initiate treatment in a timely manner. Namibia's experience demonstrates that it is feasible for a rural, low-income country to achieve high national coverage of infant testing and treatment. © 2011 Chatterjee et al; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3161890/bin/1471-2458-11-553-S1.DOC
Authors & Co-Authors
Chatterjee, Anirban
Unknown Affiliation
Tripathi, Sangeeta
United States, New York
Unicef
Gass, Robert
United States, New York
Unicef
Hamunime, Ndapewa P.
Namibia, Windhoek
Ministry of Health and Social Services
Panha, Sok
Cambodia, Phnom Penh
National Center for Hiv/aids
Kiyaga, Charles
Uganda, Kampala
Uganda Ministry of Health
Wade, Abdoulaye S.
Senegal, Dakar
Ministry of Health
Barnhart, M.
United States, New York
Unicef
Luo, Chewe
United States, New York
Unicef
Ekpini, Réné Ehounou A.
United States, New York
Unicef
Statistics
Citations: 101
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1186/1471-2458-11-553
e-ISSN:
14712458
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Approach
Systematic review
Study Locations
Namibia
Senegal
Uganda