Implementing early infant diagnosis of HIV-infection at the primary care level: experiences and challenges in Malawi
Implementing early infant diagnosis of HIV-infection at the primary care level: experiences and challenges in Malawi
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DOI：
10.2471/blt.11.100776
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发表时间：
2012-09-01
影响因子：
11.1
通讯作者：
Van Rie, Annelies
中科院分区：
文献类型：
--
作者：
Dube, Queen;Dow, Anna;Van Rie, Annelies
马拉维的国家指导方针建议，暴露于人类免疫缺陷病毒（艾滋病毒）的婴儿在6周大时进行检测。婴儿早期诊断服务的推广有限，因此只有极少数婴儿开始接受抗逆转录病毒疗法。该方案包括对孕妇进行婴儿检测教育、社区宣传、6周龄婴儿免费检测、积极追踪艾滋病毒阳性婴儿并转诊治疗和护理。当地环境该方案在马拉维布兰太尔的两个初级保健设施设立。14.5%的人艾滋病毒检测呈阳性。对这126名明显呈艾滋病毒阳性的婴儿中的103名进行了进一步检测，其中88名确认感染;其他15名结果为假阳性。干血斑的初始聚合酶链反应检测的阳性预测值（PPV）为85.4%。尽管积极追踪，但只有87.3%（110/126）最初检测呈阳性的婴儿的母亲被告知其婴儿的检测结果。58%确诊感染艾滋病毒的婴儿开始接受抗逆转录病毒治疗。经验教训在资源匮乏的情况下，在初级保健一级对婴儿艾滋病毒感染进行早期诊断是一项挑战。艾滋病毒诊断和治疗方案中的许多儿童在各个阶段都没有得到后续行动。需要具有更高PPV和护理点能力的诊断工具以及更好的抗逆转录病毒治疗基础设施，以改善对艾滋病毒暴露和艾滋病毒感染婴儿的管理。
Problem Malawi's national guidelines recommend that infants exposed to the human immunodeficiency virus (HIV) be tested at 6 weeks of age. Rollout of services for early infant diagnosis has been limited and has resulted in the initiation of antiretroviral therapy (ART) in very few infants.Approach An early infant diagnosis programme was launched. It included education of pregnant women on infant testing, community sensitization, free infant testing at 6 weeks of age, active tracing of HIV-positive infants and referral for treatment and care.Local setting The programme was established in two primary care facilities in Blantyre, Malawi.Relevant changes Of 1214 HIV-exposed infants, 71.6% presented for early diagnosis, and 14.5% of those who presented tested positive for HIV. Further testing of 103 of these 126 apparently HIV-positive infants confirmed infection in 88; the other 15 results were false positives. The initial polymerase chain reaction testing of dried blood spots had a positive predictive value (PPV) of 85.4%. Despite active tracing, only 87.3% (110/126) of the mothers of infants who initially tested positive were told their infants' test results. ART was initiated in 58% of the infants with confirmed HIV infection.Lessons learnt Early infant diagnosis of HIV infection at the primary care level in a resource-poor setting is challenging. Many children in the HIV diagnosis and treatment programme were lost to follow-up at various stages. Diagnostic tools with higher PPV and point-of-care capacity and better infrastructures for administering ART are needed to improve the management of HIV-exposed and HIV-infected infants.