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Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania

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...

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Autores principales: Nuwagaba-Biribonwoha, Harriet, Werq-Semo, Bazghina, Abdallah, Aziz, Cunningham, Amy, Gamaliel, John G, Mtunga, Sevestine, Nankabirwa, Victoria, Malisa, Isaya, Gonzalez, Luis F, Massambu, Charles, Nash, Denis, Justman, Jessica, Abrams, Elaine J
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907368/
https://www.ncbi.nlm.nih.gov/pubmed/20565786
http://dx.doi.org/10.1186/1471-2431-10-44
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author Nuwagaba-Biribonwoha, Harriet
Werq-Semo, Bazghina
Abdallah, Aziz
Cunningham, Amy
Gamaliel, John G
Mtunga, Sevestine
Nankabirwa, Victoria
Malisa, Isaya
Gonzalez, Luis F
Massambu, Charles
Nash, Denis
Justman, Jessica
Abrams, Elaine J
author_facet Nuwagaba-Biribonwoha, Harriet
Werq-Semo, Bazghina
Abdallah, Aziz
Cunningham, Amy
Gamaliel, John G
Mtunga, Sevestine
Nankabirwa, Victoria
Malisa, Isaya
Gonzalez, Luis F
Massambu, Charles
Nash, Denis
Justman, Jessica
Abrams, Elaine J
author_sort Nuwagaba-Biribonwoha, Harriet
collection PubMed
description 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.
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spelling pubmed-29073682010-07-21 Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania Nuwagaba-Biribonwoha, Harriet Werq-Semo, Bazghina Abdallah, Aziz Cunningham, Amy Gamaliel, John G Mtunga, Sevestine Nankabirwa, Victoria Malisa, Isaya Gonzalez, Luis F Massambu, Charles Nash, Denis Justman, Jessica Abrams, Elaine J BMC Pediatr Research Article 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. BioMed Central 2010-06-17 /pmc/articles/PMC2907368/ /pubmed/20565786 http://dx.doi.org/10.1186/1471-2431-10-44 Text en Copyright ©2010 Nuwagaba-Biribonwoha et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Nuwagaba-Biribonwoha, Harriet
Werq-Semo, Bazghina
Abdallah, Aziz
Cunningham, Amy
Gamaliel, John G
Mtunga, Sevestine
Nankabirwa, Victoria
Malisa, Isaya
Gonzalez, Luis F
Massambu, Charles
Nash, Denis
Justman, Jessica
Abrams, Elaine J
Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania
title Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania
title_full Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania
title_fullStr Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania
title_full_unstemmed Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania
title_short Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania
title_sort introducing a multi-site program for early diagnosis of hiv infection among hiv-exposed infants in tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907368/
https://www.ncbi.nlm.nih.gov/pubmed/20565786
http://dx.doi.org/10.1186/1471-2431-10-44
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