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Increasing uptake of HIV early infant diagnosis (EID) services
in four countries (Cambodia,
Namibia, Senegal and Uganda)
Presented by René Ekpini (United States).
S. Tripathi1, C. Kiyaga2, M. Nghatanga3, M. Chhi Vun4, A.S. Wade5, R. Gass1, A. Chatterjee1, R. Ekpini1, C. Luo1
1UNICEF Headquarters, New York, United States, 2Ministry of Health, Kampala, Uganda, 3Ministry of Health and Social Services, Windhoek, Namibia, 4Ministry of Health, Phnom Penh, Cambodia, 5Ministere de la Sante Publique, DLSI, Dakar, Senegal
Background: Diagnosis using dried blood spot (DBS) technology, sample
transportation and molecular testing offers HIV exposed infants an early opportunity
for testing and care prior to peak mortality. Despite significant investment,
there has not been substantial multi-country analysis of early infant diagnosis
(EID) to guide future programming.
Methods: Retrospective analyses were led by
Ministries of Health in Cambodia,
Namibia, Senegal and Uganda in 2009. A total of 84 EID
collection sites were reviewed, with >21,000 infants tested, (14%-91% of
national volumes/country). A
standardized questionnaire was used to review EID service delivery for national
at site level; EID sample volumes were also reviewed.
Results: Public EID services in reviewed
countries have experienced rapid scale-up with 71% to 100% of regions/provinces
nationwide per country offering EID. At
the end of 2008, EID testing coverage varied (9%/Sénégal, 15%/Cambodia 21%/Uganda, 86%/Namibia). In Namibia with
>100% HIV+ pregnant women knowing their status, EID coverage was also high.
In contrast, in Cambodia and
Uganda
where 66-68% of HIV+ pregnant women know their status, it is more challenging to
achieve EID testing coverage. Though testing has been decentralized, service
utilization remains clustered (Namibia:
33% samples from 4/230(2%) total EID sites; Cambodia
40% (2/26(8%)); Senegal: 47%(4/47(9%) in 2009); Uganda:
HCIIIs, 39% of EID sites provided 9% of total sample volume). National algorithms
encourage testing at 6 weeks, however EID age remains high (Cambodia: 5.3 months; Sénégal: 4.0m; Namibia 4.4m; Uganda 7.2m). There has been some
variation in average age in the EID programs >2yrs old (Uganda: 7.4m/Jan-2008 to 6.1m/Oct-2009; Namibia:
6.2m/Jan-2006 to 3.3m/Aug-2009).
Conclusions: Significant strides to establish and increase access to and
uptake of EID testing have been made across all countries reviewed. When
decentralizing, it is important for programming to focus on early
identification and access to the full package of exposed infant services
including EID.
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