Effect of point-of-care early infant diagnosis on antiretroviral therapy initiation and retention of patients. (17th July 2018)

• Record Type: Journal Article
• Authors: Jani, Ilesh V.; Meggi, Bindiya; Loquiha, Osvaldo; Tobaiwa, Ocean; Mudenyanga, Chishamiso; Zitha, Alcina; Mutsaka, Dadirayi; Mabunda, Nedio; Vubil, Adolfo; Bollinger, Timothy; Vojnov, Lara; Peter, Trevor F.
• Is Part Of: AIDS. Volume 32:Number 11(2018)
• Publication Date: 2018-07-17
• Subjects: antiretroviral treatment initiation -- early infant diagnosis -- point-of-care -- primary healthcare; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001846
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: We measured the effect of point-of-care (POC) early infant HIV testing on antiretroviral therapy initiation rates and retention in care among infants in Mozambique. Design: A cluster-randomized trial was conducted in 16 primary healthcare centres providing either on-site POC arm ( n = 8) or referred laboratory [standard-of-care (SOC) arm; n = 8] infant HIV testing. Methods: The primary outcomes were the proportion of HIV-positive infants initiating antiretroviral therapy within 60 days of sample collection, and the proportion of HIV-positive infants who initiated antiretroviral therapy that were retained in care at 90 days of follow-up. Results: The proportion of HIV-positive infants initiating antiretroviral therapy within 60 days of sample collection was 89.7% (157 of 175) for the POC arm and 12.8% (13 of 102) for the SOC arm [relative risk (RR)(adj) 7.34; P < 0.001]. The proportion of HIV-positive infants who initiated antiretroviral therapy that were retained in care at 90 days of follow-up was 61.6% (101 of 164) for the POC arm and 42.9% (21 of 49) for the SOC arm [RR(adj) 1.40; P < 0.027]. The median time from sample collection to antiretroviral therapy initiation was less than 1 day (interquartile range: 0–1) for the POC arm and 127 days (44–154; P < 0.001) for the SOC arm. Conclusion: POC infant HIV testing enabled clinics to more rapidly diagnose and provide treatment to HIV-infected infants. This reduced opportunities for pretreatment loss to follow-up and enabled a larger proportion of infants to receive test results and initiate antiretroviral therapy. The benefits of faster HIV diagnosis and antiretroviral treatment may also improve early retention in care.