Trends in uptake of early infant diagnosis for HIV: implementation results of the Ugandan military PMTCT program
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20211978Keywords:
Early infant diagnosis, Intervention, Trends, Impact, Military facilities, UgandaAbstract
Background: Early infant diagnosis (EID) is an important strategy of the Prevention of Mother-to-child transmission (PMTCT) and when implemented in combination with other strategies could eliminate HIV MTCT. We implemented a series of strategic interventions intended to improve EID at 9 Military facilities in Uganda and evaluated their impact on uptake of EID.
Methods: A retrospective cross-sectional design was adopted, following-up HIV Exposed Infants (HEI) at the study sites over a 2 year period, and using a data extraction tool to capture4 indicators of EID namely; number of HIV-positive mothers, number of HEI enrolled, number of PCR and rapid tests performed on HEI, and number of HIV-positive results of HEI. Scatter plots and simple linear regression were applied to demonstrate trends in EID uptake and estimate intervention impact over time. Statistical significance was assumed at p<0.05.
Results: We established incremental trends in numbers of first PCR (f [1,6]=2.8; p=0.15),third PCR (f [1,6]=8.4; p<0.05), rapid tests (f [1,6]=16.1; p<0.05) performed on HEI, and a modest decline in HIV-positivity among HEI over the study period. The intervention improved retention in PMTCT cascade to 80%, when contrasted with the national average of 70%.
Conclusions: We have demonstrated that interventions invoking pre-booking HIV-positive pregnant mothers during antenatal care, follow up of mother-baby pairs using telephone and mentor mothers and integrating EID in immunization programs can improve uptake of EID in a relatively short period, and with a positive impact on EID indicators.
References
World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach-2010 version. World Health Organization; 2010. https://www.who.int/hiv/pub/ mtct/antiretroviral2010/en/. Accessed on 20 February 2021.
World Health Organization. 'Mother-to-child transmission of HIV'. https://www.who.int/hiv/topics/mtct/about/en/#:~:text=ThetransmissionofHIVfrom,from20152520to204525. Accessed on 20 February 2021.
UNAIDS. Miles to go. Global AIDS update 2018. https://www.unaids.org/en/20180718_GR2018#:~:text=Miles%20to%20go%20%2D%20Global%20AIDS%20update%202018%20%7C%20UNAIDS&text=GENEVA%2C%2018%20July%202018%E2%80%94UNAIDS,is%20at%20a%20precarious%20point. Accessed on 20 February 2021.
Katabira ET, Kamya MR, Kalyesubula I, Namale A. National antiretroviral treatment guidelines for adults, adolescents, and children. ed. Kampala, Uganda. 2009.
Mphatswe W, Blanckenberg N, Tudor-Williams G, Prendergast A, Thobakgale C, Mkhwanazi N et al. High frequency of rapid immunological progression in African infants infected in the era of perinatal HIV prophylaxis. Aids. 2007;21(10):1253-61.
Mirkuzie AH, Hinderaker SG, Sisay MM, Moland KM, Mørkve O. Current status of medication adherence and infant follow up in the prevention of mother to child HIV transmission programme in Addis Ababa: a cohort study. Journal of the International AIDS Society. 2011;14(1):1-0.
Newell ML, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. The Lancet. 2004;364(9441):1236-43.
Cook RE, Ciampa PJ, Sidat M, Blevins M, Burlison J, Davidson MA et al. Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambezia, Mozambique. Journal of acquired immune deficiency syndromes (1999). 2011;56(4):e104.
Francke JA, Penazzato M, Hou T, Abrams EJ, MacLean RL, Myer L et al. Clinical impact and cost-effectiveness of diagnosing HIV infection during early infancy in South Africa: test timing and frequency. The Journal of infectious diseases. 2016;214(9):1319-28.
Jani I, Meggi B, Loquiha O, Tobaiwa O, Mudenyanga C, Mutsaka D et al. Effect of point-of-care testing on antiretroviral-therapy initiation rates in infants. InConference on Retroviruses and Opportunistic Infections (CROI 2017), Seattle, USA. Abstract 2017;26.
Motswere-Chirwa C, Voetsch A, Lu L, Letsholathebe V, Lekone P, Machakaire E et al. Follow-up of infants diagnosed with HIV—Early infant diagnosis program, Francistown, Botswana, 2005–2012. MMWR. Morbidity and mortality weekly report. 2014;63(7):158.
Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA et al. Early antiretroviral therapy and mortality among HIV-infected infants. New England Journal of Medicine. 2008;359(21):2233-44.
MoH. Uganda Population-Based HIV Impact Assessment (UPHIA) 2016-2017.
Izudi J, Auma S, Alege JB. Early diagnosis of HIV among infants born to HIV-positive mothers on option-B plus in Kampala, Uganda. AIDS research and treatment. 2017;2017.
Uganda/UNAIDS. 2018. https://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf. Accessed on 20 February 2021.
World Health Organization. WHO recommendations on the diagnosis of HIV infection in infants and children. World Health Organization. 2010. http://apps.who.int/iris/bitstream/handle/ 10665/44275/9789241599085_eng_Annexes.pdf;jsessionid=EDCABF59B151EBF71FA59A7333DF742E?sequence=2. Accessed on
Katabira ET. The Integrated National Guidelines for Antiretroviral Therapy, Prevention of Mother to Child Transmission of HIV and Infant & Young Child Feeding. Kampala, Uganda: Ministry of Health-Uganda. 2011.
UAC. Uganda HIV/AIDS country progress report July 2016-2017.
Kiyaga C, Sendagire H, Joseph E, McConnell I, Grosz J, Narayan V et al. Uganda's new national laboratory sample transport system: a successful model for improving access to diagnostic services for early infant HIV diagnosis and other programs. PloS one. 2013;8(11):e78609.
Pandey A, Galvani AP. The global burden of HIV and prospects for control. Lancet HIV. 2019;6(12):e809-11.
Naiwatanakul T, Voramongkol N, Punsuwan N, Lolekha R, Gass R, Thaisri H et al. Uptake of early infant diagnosis in Thailand’s national program for preventing mother‐to‐child HIV transmission and linkage to care, 2008–2011. Journal of the International AIDS Society. 2016;19(1):20511.
Anaba UC, Sam-Agudu NA, Ramadhani HO, Torbunde N, Abimiku AL, Dakum P et al. Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study. PloS one. 2019;14(7):e0220616.
Ankrah AK, Dako-Gyeke P. Factors influencing the delivery and uptake of early infant diagnosis of HIV services in Greater Accra, Ghana: A qualitative study. PloS one. 2021;16(2):e0246876.
Vrazo AC, Firth J, Amzel A, Sedillo R, Ryan J, Phelps BR. Interventions to significantly improve service uptake and retention of HIV-positive pregnant women and HIV-exposed infants along the prevention of mother-to-child transmission continuum of care: systematic review. Trop Med Int Health. 2018;23(2):136-48.
Uganda AIDS Commission. Uganda Annual Joint Aids Review Report 2019/2020
Dunning L, Kroon M, Fourie L, Ciaranello A, Myer L. Impact of birth HIV-PCR testing on the uptake at follow-up Early Infant Diagnosis (EID) services in Cape Town, South Africa. The Pediatric infectious disease journal. 2017;36(12):1159.
