Programmatic evaluation of feasibility and efficiency of at birth and 6-week, point of care HIV testing in Kenyan infant.
Programmatic evaluation of feasibility and efficiency of at birth and 6-week, point of care HIV testing in Kenyan infant.
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DOI：
10.1371/journal.pone.0240621
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Finocchario-Kessler S
中科院分区：
文献类型：
--
作者：
Wexler C;Nazir N;Maloba M;Brown M;Goggin K;Gautney B;Maosa N;Babu S;Muchoki E;Mabachi N;Lwembe R;Finocchario-Kessler S
在婴儿出生时进行检测，并采用更有效的护理点（POC）艾滋病毒诊断，可以简化EID并加快婴儿ART的启动。我们评估了出生时和6周POC检测的实施情况，以评估肯尼亚现有医院工作人员实施的有效性和可行性。4家政府医院被随机分配接受GeneXpert HIV-1 Qual（n = 2）或Alere m-PIMA（n = 2）机器进行POC检测。所有入组的HIV暴露婴儿在出生时和6周龄时都有资格接受POC检测。主要结果是重复POC测试，定义为出生时和6周龄时的测试。次要结果包括重复POC测试、POC效率（关键服务的周转时间）和运营（失败的POC结果、错失的机会）的预测因素。在626名入组婴儿中，309名（49.4%）接受了重复POC检测，115名（18.4%）在出生时检测后失访，120名（19.2%）仅在6周时接受了POC检测，80名（12.8%）未接受POC检测，2名（0.3%）接受了延迟POC检测（>12周龄）。三人（0.4%）被确定为艾滋病毒阳性。在出生（n = 424）或6周（n = 429）时进行的总计853次POC检测中，806次（94.5%）记录了有效结果，792次（98.3%）结果记录了产妇通知。从样本采集到通知的平均时间为1.08天，其中751份（94.8%）通知在样本采集的同一天。出生时和6周时的机器错误率分别为8.5%和2.5%。共有198名婴儿（出生时48名; 6周时150名）没有接受POC测试，代表错过了测试机会。在出生时进行POC检测可以简化婴儿艾滋病毒诊断，加快抗逆转录病毒治疗的启动，并可以由现有的医院工作人员实施。然而，必须解决产妇脱离接触和错过检测机会的问题，以实现出生时POC检测的全部益处。
Testing infants at birth and with more efficient point of care (POC) HIV diagnostic can streamline EID and expedite infant ART initiation. We evaluated the implementation of at birth and 6-week POC testing to assess the effectiveness and feasibility when implemented by existing hospital staff in Kenya. Four government hospitals were randomly assigned to receive a GeneXpert HIV-1 Qual (n = 2) or Alere m-PIMA (n = 2) machine for POC testing. All HIV-exposed infants enrolled were eligible to receive POC testing at birth and 6-weeks of age. The primary outcome was repeat POC testing, defined as testing both at birth and 6-weeks of age. Secondary outcomes included predictors of repeat POC testing, POC efficiency (turnaround times of key services), and operations (failed POC results, missed opportunities). Of 626 enrolled infants, 309 (49.4%) received repeat POC testing, 115 (18.4%) were lost to follow up after an at-birth test, 120 (19.2%) received POC testing at 6-weeks only, 80 (12.8%) received no POC testing, and 2 (0.3%) received delayed POC testing (>12 weeks of age). Three (0.4%) were identified as HIV-positive. Of the total 853 POC tests run at birth (n = 424) or 6-weeks (n = 429), 806 (94.5%) had a valid result documented and 792 (98.3%) results had documented maternal notification. Mean time from sample collection to notification was 1.08 days, with 751 (94.8%) notifications on the same day as sample collection. Machine error rates at birth and 6-weeks were 8.5% and 2.5%, respectively. A total of 198 infants presented for care (48 at birth; 150 at 6-weeks) without receiving a POC test, representing missed opportunities for testing. At birth POC testing can streamline infant HIV diagnosis, expedite ART initiation and can be implemented by existing hospital staff. However, maternal disengagement and missed opportunities for testing must be addressed to realize the full benefits of at birth POC testing.
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影响因子：
9.3
作者：
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DOI：
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DOI：
10.1097/qai.0000000000002372
发表时间：
2020-07-01
影响因子：
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通讯作者：
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