Paper # 158LB|
National Scale-up of Early Infant Diagnostic Testing for HIV in Uganda
Charles Kiyaga*1, S Tripathi2, I McConnell3, A Kekitinwa4, R Gass2, A Chatterjee2, R Oketch5, R Ekpini2, C Luo2, and Z Akol1
1AIDS Control Prgm, Ministry of Hlth Uganda, Kampala; 2UNICEF, New York, NY, US; 3Clinton Fndn, Kampala, Uganda; 4Baylor Uganda, Kampala; and 5UNICEF, Kampala, Uganda
Background: †Since Early Infant Diagnosis
(EID) via dried blood spot (DBS) was launched nationally in 2006, coverage has
increased dramatically. Multipronged infant identification strategies including
HCW training, documentation of exposure status on health cards, routine testing
and counseling for hospitalized children, strengthened referrals and
integration of EID into EPI outreach have been utilized. However to date, no
national level review of EID program processes or outcomes has been conducted.
Methods: †A retrospective review was completed in 20 EID
collection sites randomly selected spanning 4 regions and 5 types of health
centers. Site level program data gathered with a standardized questionnaire was
compiled with central laboratory and key informant interviews with national
counterparts. The data collection took place in Nov to Dec 2009, and analysis
begun in mid-December.
Results: †In 3 years, annual EID sample volumes rose
from ~100 in 2006 to over 30,000 in 2009, with a 10-fold increase in monthly
volumes. EID collection sites have increased from 7 (end Q4 06) to 536 (end Q3 09)
across 91 districts. Though EID began at tertiary centers, national efforts decentralized
EID throughout the health system; Health Center IIís and IIIís currently comprise
48% of the total collection sites however service utilization shows these sites
account for only 16% of EID samples collected in 2009. Significant efforts in
training have reduced the average age at testing across all sites from 7.4
months in Jan 2008 to 6.1 months in Nov 2009, with no dramatically different
trends by health structure type (Referral Hospitals: 6.4 m to 5.3 m;
HC IVs 7.5 m to 7.0 m). The positivity rate however has decreased
over time from 29.4% in Q4 06 (n = 109) to 9.9% in Q3 09 (n = 7535).
Despite adequate turn around times for EID of <30 days, preliminary analysis
shows significant attrition rates post testing, (~43% of infants EID tested
never receiving their results at 3 Referral Hospitals) and continued attrition
of HIV+ infants prior to enrolling in ART services.
Conclusions: †Strategic, ambitious planning and
strong national leadership have resulted in a rapid scale up of EID with more
children being tested at earlier ages. However challenges remain with return of
test results and follow up. A strengthening approach reinforcing exposed infant
care via boosted cotrimoxazole, counseling, early testing, and follow-up is
needed and is being rolled out to ensure maximum impact of EID.