Piloting very early infant diagnosis of HIV in Lesotho: Acceptability and feasibility among mothers, health workers and laboratory personnel
Piloting very early infant diagnosis of HIV in Lesotho: Acceptability and feasibility among mothers, health workers and laboratory personnel
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DOI：
10.1371/journal.pone.0190874
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发表时间：
2018-02-07
期刊：
影响因子：
3.7
通讯作者：
Nchephe, Matsepeli
中科院分区：
文献类型：
--
作者：
Gill, Michelle M.;Mofenson, Lynne M.;Nchephe, Matsepeli
与宫内感染HIV相关的死亡率在出生后数周内迅速上升。极早期婴儿艾滋病毒诊断（VEID）-出生后2周内检测-随后立即开始抗逆转录病毒治疗，有可能避免与宫内传播相关的死亡率。然而，我们对VEID的可接受性和可行性的了解有限。方法VEID在莱索托13个卫生机构的艾滋病毒阳性孕妇及其婴儿的观察性前瞻性队列中进行了试点。在2016年3月至7月期间，对3个地区8个研究机构中参加6周或14周产后访视的艾滋病毒阳性妇女和卫生工作者（HWs）以及地区和中心实验室工作人员进行了半结构化访谈。访谈的主题包括出生和随后的艾滋病毒检测和早期治疗的可接受性，认为VEID的挑战，和艾滋病毒出生检测程序，以及他们如何performed.ResultsInterviews进行了20名妇女，18卫生工作者和9区/中心实验室工作人员。几乎所有的母亲都认为在出生时知道自己的孩子的艾滋病毒状况是积极的。母亲和卫生工作者没有表示，出生检测影响随后接受婴儿艾滋病毒检测或诊所就诊。卫生工作者和实验室工作人员报告说，对在家分娩的母亲的随访系统薄弱，并对与额外检测要求相关的工作量增加表示关切。所有组报告周转时间延迟EID，有时结果从来没有received.ConclusionsWomen，卫生工作者，和实验室工作人员发现VEID可以接受，并支持国家实施的出生检测。然而，他们发现了EID系统中的挑战，这些挑战可能会因在诊断算法中添加测试而加剧，例如接收测试结果的延迟，这表明VEID在某些环境中可能不可行。政策制定者需要考虑是否增加出生检测或加强目前的诊所和实验室系统是最适当的行动方针。
IntroductionMortality associated with in-utero HIV infection rises rapidly within weeks after birth. Very early infant diagnosis of HIV (VEID)-testing within 2 weeks of birth-followed by immediate initiation of antiretroviral therapy has potential to avert mortality associated with in-utero transmission. However, our understanding of acceptability and feasibility of VEID is limited.MethodsVEID was piloted in an observational prospective cohort of HIV-positive pregnant women and their infants in 13 Lesotho health facilities. Between March-July 2016, semi-structured interviews were conducted with HIV-positive women attending 6-week or 14-week postnatal visits and health workers (HWs) in 8 study facilities in 3 districts as well as with district and central laboratory staff. Interview themes included acceptability of birth and subsequent HIV testing and early treatment, perceived VEID challenges, and HIV birth testing procedures and how well they were performed.ResultsInterviews were conducted with 20 women, 18 HWs and 9 district/central laboratory staff. Nearly all mothers perceived knowing their child's HIV status at birth positively. Mothers and HWs did not indicate that birth testing affected subsequent acceptance of infant HIV testing or clinic attendance. HWs and laboratory staff reported weak follow-up systems for mothers with home deliveries, and concern regarding the increased workload associated with additional testing requirements. All groups reported turnaround time delays for EID, and that sometimes results were never received.ConclusionsWomen, HWs, and laboratory staff found VEID acceptable and were supportive of national implementation of birth testing. However, they identified challenges within the EID system that could be exacerbated by adding a test to the diagnostic algorithm, such as delays in receiving test results, suggesting VEID may not be feasible in certain settings. Policymakers will need to consider whether adding birth testing or strengthening the current clinic and laboratory system is the most appropriate course of action.