Impact of Routine Point-of-Care Versus Laboratory Testing for Early Infant Diagnosis of HIV: Results From a Multicountry Stepped-Wedge Cluster-Randomized Controlled Trial.

Journal of Acquired Immune Deficiency Syndromes : JAIDS
Emma SacksRhoderick Machekano

Abstract

Although the World Health Organization recommends HIV-exposed infants receive a 6-week diagnostic test, few receive results by 12 weeks. Point-of-care (POC) early infant diagnosis (EID) may improve timely diagnosis and treatment. This study assesses the impact of routine POC versus laboratory-based EID on return of results by 12 weeks of age. This was a cluster-randomized stepped-wedge trial in Kenya and Zimbabwe. In each country, 18 health facilities were randomly selected for inclusion and randomized to timing of POC implementation. Nine thousand five hundred thirty-nine infants received tests: 5115 laboratory-based and 4424 POC. In Kenya and Zimbabwe, respectively, caregivers were 1.29 times [95% confidence interval (CI): 1.27 to 1.30, P < 0.001] and 4.56 times (95% CI: 4.50 to 4.60, P < 0.001) more likely to receive EID results by 12 weeks of age with POC versus laboratory-based EID. POC significantly reduced the time between sample collection and return of results to caregiver by an average of 23.03 days (95% CI: 4.85 to 21.21, P < 0.001) in Kenya and 62.37 days (95% CI: 58.94 to 65.80, P < 0.001) in Zimbabwe. For HIV-infected infants, POC significantly increased the percentage initiated on treatment, from 43.2% to 79.6% i...Continue Reading

References

Oct 7, 2004·Lancet·Marie-Louise NewellUNKNOWN Ghent International AIDS Society (IAS) Working Group on HIV Infection in Women and Children
Nov 21, 2008·The New England Journal of Medicine·Avy ViolariUNKNOWN CHER Study Team
Sep 8, 2015·Journal of the International AIDS Society·Lorna DunningLandon Myer
Dec 8, 2015·Journal of the International AIDS Society·Shaffiq EssajeeJessica Markby
Mar 1, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Reuben MwendaLara Vojnov

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Citations

May 18, 2021·Tropical Medicine & International Health : TM & IH·Catherine G SutcliffeWilliam J Moss
Aug 13, 2021·Implementation Science Communications·Catherine WexlerSarah Finocchario-Kessler
Nov 1, 2021·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Carla J ChibweshaJeffrey S A Stringer

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