Implementing services for Early Infant Diagnosis (EID) of HIV: a comparative descriptive analysis of national programs in four countries
Implementing services for Early Infant Diagnosis (EID) of HIV: a comparative descriptive analysis of national programs in four countries
复制标题
DOI：
10.1186/1471-2458-11-553
复制
发表时间：
2011-07-13
影响因子：
4.5
通讯作者：
Ekpini, Rene
中科院分区：
文献类型：
--
作者：
Chatterjee, Anirban;Tripathi, Sangeeta;Ekpini, Rene
背景：能够早期获得诊断和治疗的艾滋病毒感染儿童的存活率显著增加。这项多国审查的目标是检查感染艾滋病毒的婴儿和儿童在何时何地得到诊断，以及EID服务是否被最大限度地用于改善感染艾滋病毒的儿童的健康状况。方法：在非洲和亚洲的四个国家，审查了现有的文件和数据，并进行了关键的线人访谈。结果：在2006年至2009年审查的四个国家中，柬埔寨和塞内加尔的EID样本量急剧上升，达到平均每季度100份，乌干达为每季度7,000份，纳米比亚为每季度2,000份。2009年，遗址的地理覆盖面也迅速扩大到乌干达的525个、纳米比亚的205个、塞内加尔的48个和柬埔寨的26个。然而，只有一小部分检测是在较低级别的卫生设施进行的：在乌干达，卫生中心IIs和IIIS占EID收集点的47%，但只占全部检测的11%，在纳米比亚，收集的EID点占所有样本的15%&93%。除纳米比亚外，在所有国家，超过50%的开斋节检测是在2个月后进行的。很少有网站在EID和ART之间有强大的转介机制。在儿童的一个子样本中，我们注意到婴儿在测试后的连续护理过程中出现了显著的磨损。只有22%(塞内加尔)、37%(乌干达)和38%(柬埔寨)的聚合酶链式反应检测呈阳性的婴儿随后开始接受治疗。在几乎全面覆盖EID的纳米比亚，超过70%的PCR阳性婴儿在2008年开始接受抗逆转录病毒治疗。结论：在EID检测大幅扩大的同时，很大比例的PCR阳性婴儿是从治疗开始的。随着EID服务规模的不断扩大，需要更多的方案关注和支持，以留住感染艾滋病毒的婴儿，并确保那些检测呈阳性的婴儿及时开始治疗。纳米比亚的经验表明，对于一个农村、低收入国家来说，实现全国婴儿检测和治疗的高覆盖率是可行的。
Background: There is a significant increase in survival for HIV-infected children who have early access to diagnosis and treatment. The goal of this multi-country review was to examine when and where HIV-exposed infants and children are being diagnosed, and whether the EID service is being maximally utilized to improve health outcomes for HIV-exposed children.Methods: In four countries across Africa and Asia existing documents and data were reviewed and key informant interviews were conducted. EID testing data was gathered from the central testing laboratories and was then complemented by health facility level data extraction which took place using a standardized and validated questionnaireResults: In the four countries reviewed from 2006 to 2009 EID sample volumes rose dramatically to an average of >100 samples per quarter in Cambodia and Senegal, >7,000 samples per quarter in Uganda, and >2,000 samples per quarter in Namibia. Geographic coverage of sites also rapidly expanded to 525 sites in Uganda, 205 in Namibia, 48 in Senegal, and 26 in Cambodia in 2009. However, only a small proportion of testing was done at lower-level health facilities: in Uganda Health Center IIs and IIIs comprised 47% of the EID collection sites, but only 11% of the total tests, and in Namibia 15% of EID sites collected >93% of all samples. In all countries except for Namibia, more than 50% of the EID testing was done after 2 months of age. Few sites had robust referral mechanisms between EID and ART. In a sub-sample of children, we noted significant attrition of infants along the continuum of care post testing. Only 22% (Senegal), 37% (Uganda), and 38% (Cambodia) of infants testing positive by PCR were subsequently initiated onto treatment. In Namibia, which had almost universal EID coverage, more than 70% of PCR-positive infants initiated ART in 2008.Conclusions: While EID testing has expanded dramatically, a large proportion of PCR-positive infants are initiated on treatment. As EID services continue to scale-up, more programmatic attention and support is needed to retain HIV-exposed infants in care and ensure that those testing positive initiate treatment in a timely manner. Namibia's experience demonstrates that it is feasible for a rural, low-income country to achieve high national coverage of infant testing and treatment.