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Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy
INTRODUCTION: Novel approaches to case identification and linkage to antiretroviral therapy (ART) are needed to close gaps in early infant diagnosis (EID) of HIV. Point-of-care (POC) EID is a recent innovation that eliminates the long turnaround times of conventional EID that limit patient managemen...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Global Health: Science and Practice
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087433/ https://www.ncbi.nlm.nih.gov/pubmed/33684058 http://dx.doi.org/10.9745/GHSP-D-20-00611 |
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author | Matsinhe, Mércia Bollinger, Timothy Lee, Nilza Loquiha, Osvaldo Meggi, Bindiya Mabunda, Nédio Mudenyanga, Chishamiso Mutsaka, Dadirayi Florêncio, Marcelina Mucaringua, Aurora Macassa, Eugénia Seni, Amir Jani, Ilesh Buck, W. Chris |
author_facet | Matsinhe, Mércia Bollinger, Timothy Lee, Nilza Loquiha, Osvaldo Meggi, Bindiya Mabunda, Nédio Mudenyanga, Chishamiso Mutsaka, Dadirayi Florêncio, Marcelina Mucaringua, Aurora Macassa, Eugénia Seni, Amir Jani, Ilesh Buck, W. Chris |
author_sort | Matsinhe, Mércia |
collection | PubMed |
description | INTRODUCTION: Novel approaches to case identification and linkage to antiretroviral therapy (ART) are needed to close gaps in early infant diagnosis (EID) of HIV. Point-of-care (POC) EID is a recent innovation that eliminates the long turnaround times of conventional EID that limit patient management in the inpatient setting. The initial deployment of POC EID in Mozambique focused primarily on outpatient clinics; however, 2 high-volume tier-4 pediatric referral hospitals were also included. METHODS: To assess the impact of inpatient POC EID, a retrospective review of testing and care data from Hospital Central de Beira (HCB) and Hospital Central de Maputo (HCM) was performed for the period September 2017 to July 2018, with comparison to the 8-month pre-POC period when dried blood spots were used for conventional EID. RESULTS: Monthly testing volume increased from 8.5 tests pre-POC to 17.6 tests with POC (P<.001). Among 511 children with POC testing, the median age was 5 months, there was ongoing breastfeeding in 326 (63.8%), and 136 (26.6%) of mothers and 146 (28.6%) of infants had not received ART or antiretroviral prophylaxis, respectively. POC tests were positive in 152 (29.7%) infants, and 52 (37.5%) had a previous negative DNA polymerase chain reaction through the conventional outpatient EID program. Linkage to ART for infants with HIV-positive tests improved 64% during the POC period (P=.002). Inpatient mortality for infected infants during the POC period was 28.2%. Excluding these deaths, 61.2% of eligible infants initiated ART as inpatients, but only 29.8% of those discharged without ART were confirmed to have initiated as outpatients. CONCLUSIONS: Inpatient wards are a high-yield site for EID and ART initiation that have historically been overlooked in programming for prevention of mother-to-child transmission. POC platforms represent a transformative opportunity to increase inpatient testing, make definitive diagnoses, and improve timely linkage to ART. Scale-up plans should prioritize pediatric wards. |
format | Online Article Text |
id | pubmed-8087433 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Global Health: Science and Practice |
record_format | MEDLINE/PubMed |
spelling | pubmed-80874332021-05-04 Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy Matsinhe, Mércia Bollinger, Timothy Lee, Nilza Loquiha, Osvaldo Meggi, Bindiya Mabunda, Nédio Mudenyanga, Chishamiso Mutsaka, Dadirayi Florêncio, Marcelina Mucaringua, Aurora Macassa, Eugénia Seni, Amir Jani, Ilesh Buck, W. Chris Glob Health Sci Pract Original Articles INTRODUCTION: Novel approaches to case identification and linkage to antiretroviral therapy (ART) are needed to close gaps in early infant diagnosis (EID) of HIV. Point-of-care (POC) EID is a recent innovation that eliminates the long turnaround times of conventional EID that limit patient management in the inpatient setting. The initial deployment of POC EID in Mozambique focused primarily on outpatient clinics; however, 2 high-volume tier-4 pediatric referral hospitals were also included. METHODS: To assess the impact of inpatient POC EID, a retrospective review of testing and care data from Hospital Central de Beira (HCB) and Hospital Central de Maputo (HCM) was performed for the period September 2017 to July 2018, with comparison to the 8-month pre-POC period when dried blood spots were used for conventional EID. RESULTS: Monthly testing volume increased from 8.5 tests pre-POC to 17.6 tests with POC (P<.001). Among 511 children with POC testing, the median age was 5 months, there was ongoing breastfeeding in 326 (63.8%), and 136 (26.6%) of mothers and 146 (28.6%) of infants had not received ART or antiretroviral prophylaxis, respectively. POC tests were positive in 152 (29.7%) infants, and 52 (37.5%) had a previous negative DNA polymerase chain reaction through the conventional outpatient EID program. Linkage to ART for infants with HIV-positive tests improved 64% during the POC period (P=.002). Inpatient mortality for infected infants during the POC period was 28.2%. Excluding these deaths, 61.2% of eligible infants initiated ART as inpatients, but only 29.8% of those discharged without ART were confirmed to have initiated as outpatients. CONCLUSIONS: Inpatient wards are a high-yield site for EID and ART initiation that have historically been overlooked in programming for prevention of mother-to-child transmission. POC platforms represent a transformative opportunity to increase inpatient testing, make definitive diagnoses, and improve timely linkage to ART. Scale-up plans should prioritize pediatric wards. Global Health: Science and Practice 2021-03-31 /pmc/articles/PMC8087433/ /pubmed/33684058 http://dx.doi.org/10.9745/GHSP-D-20-00611 Text en © Matsinhe et al. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00611 |
spellingShingle | Original Articles Matsinhe, Mércia Bollinger, Timothy Lee, Nilza Loquiha, Osvaldo Meggi, Bindiya Mabunda, Nédio Mudenyanga, Chishamiso Mutsaka, Dadirayi Florêncio, Marcelina Mucaringua, Aurora Macassa, Eugénia Seni, Amir Jani, Ilesh Buck, W. Chris Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy |
title | Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy |
title_full | Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy |
title_fullStr | Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy |
title_full_unstemmed | Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy |
title_short | Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy |
title_sort | inpatient point-of-care hiv early infant diagnosis in mozambique to improve case identification and linkage to antiretroviral therapy |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087433/ https://www.ncbi.nlm.nih.gov/pubmed/33684058 http://dx.doi.org/10.9745/GHSP-D-20-00611 |
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