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Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants

BACKGROUND: Improving efforts toward elimination of mother-to-child transmission of HIV requires timely early infant diagnosis (EID) among all HIV-exposed infants, but the occurrence of timely EID and infant survival may be underascertained in routine, facility-bound program data. METHODS: From Marc...

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Autores principales: Webb, Karen, Chitiyo, Vivian, Mahachi, Nyikadzino, Huruva Mukungunugwa, Solomon, Mushavi, Angela, Zizhou, Simukai, Engelsmann, Barbara, Abbas Ferrand, Rashida, Neuman, Melissa, Hartogensis, Wendy, Geng, Elvin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JAIDS Journal of Acquired Immune Deficiency Syndromes 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012331/
https://www.ncbi.nlm.nih.gov/pubmed/31913988
http://dx.doi.org/10.1097/QAI.0000000000002263
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author Webb, Karen
Chitiyo, Vivian
Mahachi, Nyikadzino
Huruva Mukungunugwa, Solomon
Mushavi, Angela
Zizhou, Simukai
Engelsmann, Barbara
Abbas Ferrand, Rashida
Neuman, Melissa
Hartogensis, Wendy
Geng, Elvin
author_facet Webb, Karen
Chitiyo, Vivian
Mahachi, Nyikadzino
Huruva Mukungunugwa, Solomon
Mushavi, Angela
Zizhou, Simukai
Engelsmann, Barbara
Abbas Ferrand, Rashida
Neuman, Melissa
Hartogensis, Wendy
Geng, Elvin
author_sort Webb, Karen
collection PubMed
description BACKGROUND: Improving efforts toward elimination of mother-to-child transmission of HIV requires timely early infant diagnosis (EID) among all HIV-exposed infants, but the occurrence of timely EID and infant survival may be underascertained in routine, facility-bound program data. METHODS: From March 2015 to May 2015, we traced a random sample of HIV-positive mother and HIV-exposed infant pairs lost to follow-up for EID in facility registers in Zimbabwe. We incorporated updated information into weighted survival analyses to estimate incidence of EID and death. Reasons for no EID were surveyed from caregivers. RESULTS: Among 2651 HIV-positive women attending antenatal care, 1823 (68.8%) infants had no documented EID by 3 months of age. Among a random sample of 643 (35.3%) HIV-exposed infants lost to follow-up for EID, vital status was ascertained among 371 (57.7%) and updated care status obtained from 256 (39.8%) mothers traced. Among all HIV-infected mother–HIV-exposed infant pairs, weighted estimates found cumulative incidence of infant death by 90 days of 3.9% (95% confidence interval: 3.4% to 4.4%). Cumulative incidence of timely EID with death as a competing risk was 60%. The most frequently cited reasons for failure to uptake EID were “my child died” and “I didn't know I should have my child tested.” CONCLUSIONS: Our findings indicate uptake of timely EID among HIV-exposed infants is underestimated in routine health information systems. High, early mortality among HIV-exposed infants underscores the need to more effectively identify HIV-positive mother–HIV exposed infant pairs at high risk of adverse outcomes and loss to follow-up for enhanced interventions.
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spelling pubmed-70123312020-02-19 Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants Webb, Karen Chitiyo, Vivian Mahachi, Nyikadzino Huruva Mukungunugwa, Solomon Mushavi, Angela Zizhou, Simukai Engelsmann, Barbara Abbas Ferrand, Rashida Neuman, Melissa Hartogensis, Wendy Geng, Elvin J Acquir Immune Defic Syndr Clinical Science BACKGROUND: Improving efforts toward elimination of mother-to-child transmission of HIV requires timely early infant diagnosis (EID) among all HIV-exposed infants, but the occurrence of timely EID and infant survival may be underascertained in routine, facility-bound program data. METHODS: From March 2015 to May 2015, we traced a random sample of HIV-positive mother and HIV-exposed infant pairs lost to follow-up for EID in facility registers in Zimbabwe. We incorporated updated information into weighted survival analyses to estimate incidence of EID and death. Reasons for no EID were surveyed from caregivers. RESULTS: Among 2651 HIV-positive women attending antenatal care, 1823 (68.8%) infants had no documented EID by 3 months of age. Among a random sample of 643 (35.3%) HIV-exposed infants lost to follow-up for EID, vital status was ascertained among 371 (57.7%) and updated care status obtained from 256 (39.8%) mothers traced. Among all HIV-infected mother–HIV-exposed infant pairs, weighted estimates found cumulative incidence of infant death by 90 days of 3.9% (95% confidence interval: 3.4% to 4.4%). Cumulative incidence of timely EID with death as a competing risk was 60%. The most frequently cited reasons for failure to uptake EID were “my child died” and “I didn't know I should have my child tested.” CONCLUSIONS: Our findings indicate uptake of timely EID among HIV-exposed infants is underestimated in routine health information systems. High, early mortality among HIV-exposed infants underscores the need to more effectively identify HIV-positive mother–HIV exposed infant pairs at high risk of adverse outcomes and loss to follow-up for enhanced interventions. JAIDS Journal of Acquired Immune Deficiency Syndromes 2020-03-01 2020-01-06 /pmc/articles/PMC7012331/ /pubmed/31913988 http://dx.doi.org/10.1097/QAI.0000000000002263 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Science
Webb, Karen
Chitiyo, Vivian
Mahachi, Nyikadzino
Huruva Mukungunugwa, Solomon
Mushavi, Angela
Zizhou, Simukai
Engelsmann, Barbara
Abbas Ferrand, Rashida
Neuman, Melissa
Hartogensis, Wendy
Geng, Elvin
Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants
title Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants
title_full Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants
title_fullStr Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants
title_full_unstemmed Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants
title_short Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants
title_sort brief report: improving early infant diagnosis observations: estimates of timely hiv testing and mortality among hiv-exposed infants
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012331/
https://www.ncbi.nlm.nih.gov/pubmed/31913988
http://dx.doi.org/10.1097/QAI.0000000000002263
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