Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions.
Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions.
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DOI：
10.1186/1741-7015-9-59
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发表时间：
2011-05-20
期刊：
影响因子：
9.3
通讯作者：
Leroy V
中科院分区：
文献类型：
--
作者：
Ciaranello AL;Park JE;Ramirez-Avila L;Freedberg KA;Walensky RP;Leroy V
HIV-1感染的早期婴儿诊断（EID）为HIV感染和未感染HIV的婴儿、其家庭以及提供预防母婴传播（PMTCT）服务的方案带来了实质性的好处，但在资源有限的环境中实施具有挑战性。为了正确告知父母/照顾者婴儿感染状况，并将感染艾滋病毒的婴儿与护理和治疗联系起来，必须成功地发生“级联”事件。扩展EID计划的一个经常提到的障碍是所需实验室测定的成本。然而，在级联的每一步都存在着实质性的执行障碍以及人员和基础设施要求。在本次更新中，我们回顾了EID级联中每个步骤的吸收挑战，强调即使报告的吸收水平最高，近一半的艾滋病毒感染婴儿可能无法成功完成级联。接下来，我们综合现有文献的成本和成本效益的EID计划，确定未来的研究领域，并将这些研究结果的背景下的好处和挑战EID实施资源有限的设置。
Early infant diagnosis (EID) of HIV-1 infection confers substantial benefits to HIV-infected and HIV-uninfected infants, to their families, and to programs providing prevention of mother-to-child transmission (PMTCT) services, but has been challenging to implement in resource-limited settings. In order to correctly inform parents/caregivers of infant infection status and link HIV-infected infants to care and treatment, a 'cascade' of events must successfully occur. A frequently cited barrier to expansion of EID programs is the cost of the required laboratory assays. However, substantial implementation barriers, as well as personnel and infrastructure requirements, exist at each step in the cascade. In this update, we review challenges to uptake at each step in the EID cascade, highlighting that even with the highest reported levels of uptake, nearly half of HIV-infected infants may not complete the cascade successfully. We next synthesize the available literature about the costs and cost effectiveness of EID programs; identify areas for future research; and place these findings within the context of the benefits and challenges to EID implementation in resource-limited settings.
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