Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks?
Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks?
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DOI：
10.1371/journal.pone.0184769
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发表时间：
2017-10-10
期刊：
影响因子：
3.7
通讯作者：
Guay, Laura
中科院分区：
文献类型：
--
作者：
Tiam, Appolinaire;Gill, Michelle M.;Guay, Laura
前言婴儿早期诊断是识别围产期或宫内儿童感染HIV的重要步骤。多种因素导致HIV感染儿童抗逆转录病毒治疗开始延迟，包括婴儿早期HIV诊断病例的延迟。方法我们进行了一项回顾性研究，以评估莱索托婴儿早期诊断的周转时间。训练有素的工作人员审查了2011年期间接受艾滋病毒检测的艾滋病毒感染婴儿(6-8周)的记录。研究地点来自莱索托的高地、山麓和低地地区。中央实验室数据库数据与设施和实验室登记信息相联系。使用线性混合模型计算周转时间几何平均值(95%可信区间)并按地区进行比较。结果回顾了来自25个机构的1187个婴儿个体记录。总体而言，早期婴儿诊断周转时间为61.7天(95%可信区间：55.3-68.7)。从标本采集到地区实验室的平均时间为14天(95%可信区间：12.1~16.1)，从地区实验室到中心实验室的平均时间为2天(95%可信区间0.8~5.2)，结果从中心实验室到地区医院的平均时间为23.3天(95%可信区间：18.7~29.0)，从地区医院到卫生机构的平均时间为3.2天(95%可信区间1.9~5.5)，从卫生机构到护理者的平均时间为10.4天(95%可信区间7.9~13.5)。低地地区从标本转移到中心实验室和结果从中心实验室转移到地区医院的平均时间(分别为0.9d和16.2d)明显短于高地地区(6.0d[P=0.030]和34.3d[P=0.0099])。与未感染艾滋病毒的婴儿相比，感染艾滋病毒的婴儿从抽血到接受结果的周转时间显著缩短[p=0.0036]，平均分别为47.1天(95%可信区间：38.9-56.9)和62天(95%可信区间：55.9-68.7)。在47名HIV感染婴儿中，36名在照顾者收到结果后平均1.3天(95%CI：0.3，5.7)开始接受抗逆转录病毒治疗。结论HIV感染婴儿较早获得结果，一旦结果提供给照顾者，就会迅速开始抗逆转录病毒治疗。然而，早期婴儿诊断的平均周转时间为两个月；最长的延误时间是将结果从中心实验室转移到地区医院。基于地理区域或医院与保健中心之间的结果周转时间各不相同，但没有达到统计学意义。
IntroductionEarly infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade.MethodsWe conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means (with 95% CI) were calculated and compared by region using linear mixed models.Results1,187 individual infant records from 25 facilities were reviewed. Overall, early infant diagnosis turnaround time was 61.7 days (95% CI: 55.3-68.7). Mean time from specimen collection to district laboratory was 14 days (95% CI: 12.1-16.1); from district to central laboratory, 2 days (95% CI 0.8-5.2); results from central laboratory to district hospital, 23.3 days (95% CI: 18.7-29.0); from district hospital to health facility, 3.2 days (95% CI 1.9-5.5); and from health facility to caregiver, 10.4 days (95% CI, 7.9-13.5). Mean times from specimen transfer to the central laboratory and for result transfer from central laboratory to district hospital were significantly shorter in the Lowlands Region (0.9 and 16.2 days, respectively), compared to Highlands Region (6.0 [P = 0.030] and 34.3 days [P = 0.0099]. Turnaround time from blood draw to receipt of results was significantly shorter for HIV infected infants compared to HIV uninfected infants [p = 0.0036] at an average of 47.1 days (95% CI: 38.9-56.9) and 62 days (95% CI: 55.9-68.7) respectively. Of 47 HIV-infected infants, 36 were initiated on antiretroviral therapy at an average of 1.3 days (95% CI: 0.3, 5.7) after caregiver received the result.ConclusionHIV-infected infants received results earlier and were rapidly initiated on antiretroviral therapy once the result was delivered to caregiver. However, average early infant diagnosis turnaround time was two months; the longest period of delay was transfer of results from central laboratory to district hospital. Turnaround time of results based on geographical regions or between hospitals and health centres varied but did not reach statistical significance.