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Early infant diagnosis of HIV in three regions in Tanzania; successes and challenges.

Chiduo MG, Mmbando BP, Theilgaard ZP, Bygbjerg IC, Gerstoft J, Lemnge M, Katzenstein TL - BMC Public Health (2013)

Bottom Line: A total of 452 (10.5%) were found to be HIV infected (judged by the result of the first test).However sample turnaround time was significantly shorter in both Mbeya (2.7 weeks) and Tanga (5.0 weeks) as compared to Kilimanjaro (7.0 weeks), p=<0.001.Among the infants who were receiving treatment, 61% were found to be LFTU during the review period.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Institute for Medical Research Tanga Centre, Bombo Road, Box 5004, Tanga, Tanzania. mercy_chiduo@yahoo.com.

ABSTRACT

Background: By the end of 2009 an estimated 2.5 million children worldwide were living with HIV-1, mostly as a consequence of vertical transmission, and more than 90% of these children live in sub-Saharan Africa. In 2008 the World Health Organization (WHO), recommended early initiation of Highly Active Antiretroviral Therapy (HAART) to all HIV infected infants diagnosed within the first year of life, and since 2010, within the first two years of life, irrespective of CD4 count or WHO clinical stage. The study aims were to describe implementation of EID programs in three Tanzanian regions with differences in HIV prevalences and logistical set-up with regard to HIV DNA testing.

Methods: Data were obtained by review of the prevention from mother to child transmission of HIV (PMTCT) registers from 2009-2011 at the Reproductive and Child Health Clinics (RCH) and from the databases from the Care and Treatment Clinics (CTC) in all the three regions; Kilimanjaro, Mbeya and Tanga. Statistical tests used were Poisson regression model and rank sum test.

Results: During the period of 2009 - 2011 a total of 4,860 exposed infants were registered from the reviewed sites, of whom 4,292 (88.3%) were screened for HIV infection. Overall proportion of tested infants in the three regions increased from 77.2% in 2009 to 97.8% in 2011. A total of 452 (10.5%) were found to be HIV infected (judged by the result of the first test). The prevalence of HIV infection among infants was higher in Mbeya when compared to Kilimanjaro region RR = 1.872 (95%CI = 1.408 - 2.543) p < 0.001. However sample turnaround time was significantly shorter in both Mbeya (2.7 weeks) and Tanga (5.0 weeks) as compared to Kilimanjaro (7.0 weeks), p=<0.001. A substantial of loss to follow-up (LTFU) was evident at all stages of EID services in the period of 2009 to 2011. Among the infants who were receiving treatment, 61% were found to be LFTU during the review period.

Conclusion: The study showed an increase in testing of HIV exposed infants within the three years, there is large variations of HIV prevalence among the regions. Challenges like; sample turnaround time and LTFU must be overcome before this can translate into the intended goal of early initiation of lifelong lifesaving antiretroviral therapy for the infants.

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Stages of EID from RCH to CTC; proportions of HIV positive infants referred, reported to CTC, and infants who initiated treatment and retained at the CTC during 2009–2011.
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Figure 4: Stages of EID from RCH to CTC; proportions of HIV positive infants referred, reported to CTC, and infants who initiated treatment and retained at the CTC during 2009–2011.

Mentions: Overall, the proportion of HIV infected infants referred to CTC was higher in Kilimanjaro (95.5%) and Mbeya (99.2%) than in Tanga (71.4%). Between 2009 and 2011 these proportions were almost the same (>95%) in Kilimanjaro and Mbeya, while in Tanga region, the proportion was lowest (<50%) in 2010, but increased to over 95% in 2011. Among the infants who reported to the CTC in Kilimanjaro region almost all started ART; in 2009 about 41% of the HIV infected infants reported to CTC and all of them initiated treatment, the trend was the same in 2010 and 2011, Figure 4. The figure shows that the proportion of infants reporting to CTC, initiating and being retained on treatment in Mbeya increased substantially across the years, a similar pattern was found in Tanga between 2010 and 2011.


Early infant diagnosis of HIV in three regions in Tanzania; successes and challenges.

Chiduo MG, Mmbando BP, Theilgaard ZP, Bygbjerg IC, Gerstoft J, Lemnge M, Katzenstein TL - BMC Public Health (2013)

Stages of EID from RCH to CTC; proportions of HIV positive infants referred, reported to CTC, and infants who initiated treatment and retained at the CTC during 2009–2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852479&req=5

Figure 4: Stages of EID from RCH to CTC; proportions of HIV positive infants referred, reported to CTC, and infants who initiated treatment and retained at the CTC during 2009–2011.
Mentions: Overall, the proportion of HIV infected infants referred to CTC was higher in Kilimanjaro (95.5%) and Mbeya (99.2%) than in Tanga (71.4%). Between 2009 and 2011 these proportions were almost the same (>95%) in Kilimanjaro and Mbeya, while in Tanga region, the proportion was lowest (<50%) in 2010, but increased to over 95% in 2011. Among the infants who reported to the CTC in Kilimanjaro region almost all started ART; in 2009 about 41% of the HIV infected infants reported to CTC and all of them initiated treatment, the trend was the same in 2010 and 2011, Figure 4. The figure shows that the proportion of infants reporting to CTC, initiating and being retained on treatment in Mbeya increased substantially across the years, a similar pattern was found in Tanga between 2010 and 2011.

Bottom Line: A total of 452 (10.5%) were found to be HIV infected (judged by the result of the first test).However sample turnaround time was significantly shorter in both Mbeya (2.7 weeks) and Tanga (5.0 weeks) as compared to Kilimanjaro (7.0 weeks), p=<0.001.Among the infants who were receiving treatment, 61% were found to be LFTU during the review period.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Institute for Medical Research Tanga Centre, Bombo Road, Box 5004, Tanga, Tanzania. mercy_chiduo@yahoo.com.

ABSTRACT

Background: By the end of 2009 an estimated 2.5 million children worldwide were living with HIV-1, mostly as a consequence of vertical transmission, and more than 90% of these children live in sub-Saharan Africa. In 2008 the World Health Organization (WHO), recommended early initiation of Highly Active Antiretroviral Therapy (HAART) to all HIV infected infants diagnosed within the first year of life, and since 2010, within the first two years of life, irrespective of CD4 count or WHO clinical stage. The study aims were to describe implementation of EID programs in three Tanzanian regions with differences in HIV prevalences and logistical set-up with regard to HIV DNA testing.

Methods: Data were obtained by review of the prevention from mother to child transmission of HIV (PMTCT) registers from 2009-2011 at the Reproductive and Child Health Clinics (RCH) and from the databases from the Care and Treatment Clinics (CTC) in all the three regions; Kilimanjaro, Mbeya and Tanga. Statistical tests used were Poisson regression model and rank sum test.

Results: During the period of 2009 - 2011 a total of 4,860 exposed infants were registered from the reviewed sites, of whom 4,292 (88.3%) were screened for HIV infection. Overall proportion of tested infants in the three regions increased from 77.2% in 2009 to 97.8% in 2011. A total of 452 (10.5%) were found to be HIV infected (judged by the result of the first test). The prevalence of HIV infection among infants was higher in Mbeya when compared to Kilimanjaro region RR = 1.872 (95%CI = 1.408 - 2.543) p < 0.001. However sample turnaround time was significantly shorter in both Mbeya (2.7 weeks) and Tanga (5.0 weeks) as compared to Kilimanjaro (7.0 weeks), p=<0.001. A substantial of loss to follow-up (LTFU) was evident at all stages of EID services in the period of 2009 to 2011. Among the infants who were receiving treatment, 61% were found to be LFTU during the review period.

Conclusion: The study showed an increase in testing of HIV exposed infants within the three years, there is large variations of HIV prevalence among the regions. Challenges like; sample turnaround time and LTFU must be overcome before this can translate into the intended goal of early initiation of lifelong lifesaving antiretroviral therapy for the infants.

Show MeSH
Related in: MedlinePlus