The Cascade of Care From Routine Point-of-Care HIV Testing at Birth: Results From an 18-Months Pilot Program in Eswatini.
The Cascade of Care From Routine Point-of-Care HIV Testing at Birth: Results From an 18-Months Pilot Program in Eswatini.
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DOI：
10.1097/qai.0000000000002380
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发表时间：
2020-07-01
期刊：
影响因子：
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通讯作者：
Cohn, Jennifer
中科院分区：
文献类型：
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作者：
Khumalo, Philisiwe Ntombenhle;Sacks, Emma;Cohn, Jennifer
背景：出生时的艾滋病毒检测可能会改善早期治疗，但对婴儿的可行性和留住婴儿的关注仍然存在。2017年，在埃斯瓦蒂尼的3家大批量孕产妇保健机构的常规护理中引入了临床点(POC)艾滋病毒出生检测。方法：为在3个母亲出生或分娩3天内出生的艾滋病毒感染婴儿(HEI)提供POC出生检测。数据来源于2017年8月1日至2018年11月30日期间进行的所有检测的特定项目EID检测申请表和常规登记，包括出生时检测阴性的婴儿在6-8周复查，出生时HIV检测阳性的婴儿在HIV护理和病毒载量抑制方面保留6个月。结果：在4322例符合条件的HEI中，3311例(76.6%)被检测。26名感染艾滋病毒的婴儿被确认(阳性率为0.8%)，25名开始接受抗逆转录病毒治疗(ART)(96.1%)。从样本采集到开始抗逆转录病毒治疗的中位时间为20.50天(IQR 14-45)。21名(84%)接受抗逆转录病毒治疗的婴儿在6个月后开始接受抗逆转录病毒治疗。19名婴儿(90.5%)在6个月时有病毒载量测试信息，16名婴儿(84.2%)病毒抑制。在出生时HEI检测阴性的3126名婴儿中，3004名(96.1%)与实验室数据库相连，2744名(91.3%)在6-8周复查，另有9名(0.3%)HIV阳性婴儿。结论：在HIV阳性较低的埃斯瓦蒂尼，POC出生测试的摄取率很高。几乎所有出生时被确认为艾滋病毒阳性的婴儿都接受了抗逆转录病毒治疗，并在护理和病毒抑制方面保持了很高的保留率。生育测试似乎并没有显著减少随后6-8周的测试。
BACKGROUND: HIV testing at birth may improve early treatment, but concerns remain about feasibility and retention of infants in care. In 2017, point-of-care (POC) HIV birth testing was introduced into routine care at 3 high-volume maternity health facilities in Eswatini.METHODS: POC birth testing was offered to HIV-exposed infants (HEI) born at, or presenting to, 3 maternities within 3 days of birth. Data were collected from a project-specific EID test request form and routine registers on all tests conducted from August 1, 2017 to November 30, 2018, including retesting at 6-8 weeks for infants testing negative at birth and six-month retention in HIV care and viral load suppression among infants testing HIV-positive at birth.RESULTS: Of 4322 eligible HEI, 3311 (76.6%) were tested. Twenty-six HIV-infected infants were identified (positivity rate 0.8%) and 25 initiated on antiretroviral therapy (ART) (96.1%). The median time from sample collection to ART initiation was 20.50 days (IQR 14-45). Twenty-one (84%) ART-initiated infants were on ART at 6 months after initiation. Nineteen infants (90.5%) had viral load test information at 6 months and 16 (84.2%) were virally suppressed. Of 3126 HEI testing negative at birth, 3004 (96.1%) were linked to laboratory databases and 2744 (91.3%) were retested at 6-8 weeks, with 9 (0.3%) additional infants testing HIV-positive.CONCLUSIONS: Uptake of POC birth testing was high in Eswatini with low HIV positivity. Almost all infants identified HIV-positive at birth were initiated on ART, with high retention in care and viral suppression. Birth testing did not seem to significantly reduce subsequent 6-8-week testing.