Significant Patient Impact Observed Upon Implementation of Point-of-Care Early Infant Diagnosis Technologies in an Observational Study in Malawi. (27th February 2018)

• Record Type: Journal Article
• Authors: Mwenda, Reuben; Fong, Youyi; Magombo, Termson; Saka, Emmanuel; Midiani, Dalitso; Mwase, Christopher; Kandulu, James; Wang, Melody; Thomas, Rachel; Sherman, Judith; Vojnov, Lara
• Is Part Of: Clinical infectious diseases. Volume 67:Number 5(2018)
• Page Start: 701
• Page End: 707
• Publication Date: 2018-02-27
• Subjects: point-of-care -- early infant diagnosis -- HIV -- ART initiation; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciy169
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : We conducted an observational study in Malawi to understand the patient impact of implementing point-of-care early infant diagnosis (POC EID). Antiretroviral treatment initiation rates were significantly improved with the implementation of same-day POC EID testing compared with referred, longer-turnaround laboratory-based testing. Abstract: Background: In Malawi in 2014, <20% of human immunodeficiency virus (HIV)–exposed infants received an early infant diagnosis (EID) test in the first 2 months of life and only 30% of HIV-infected children were on antiretroviral therapy (ART). We sought to understand the potential patient impact of improving timely infant diagnosis and treatment initiation through implementation of point-of-care (POC) EID technologies in Malawi. Methods: In this observational study, POC EID technologies were introduced into routine services at 7 health facilities across Malawi in September 2015. The primary outcome was the proportion of HIV-infected infants initiating ART within 60 days of sample collection in the POC arm compared to the baseline arm with conventional laboratory-based EID testing. Results: The time from sample collection to result received by the patient decreased significantly from 56 days (interquartile range [IQR], 30–81 days) in the baseline arm to <1 day in the POC arm ( P < .001). Of the HIV-infected infants, the time between sample collection and ART initiation was reduced from 38 days (IQR, 30–54 days) in the baseline arm to <1 day (IQR, 0–1 day) in the POC arm ( P = .019). Furthermore, the proportion of HIV-infected infants initiated on ART within 60 days of sample collection increased significantly from 41.9% to 91.1% after the introduction of POC (adjusted risk ratio, 2.28; P < .001). Conclusions: ART initiation rates were significantly improved with the implementation of same-day POC EID testing compared with referred, longer-turnaround laboratory-based testing.