Points for DiscussionScaling Up Early Infant Diagnosis

Session SUSS0303

18 July 2010, Vienna

Matt Barnhart, UNICEF

Agenda

0

10

20

30

40

50

PositivePCR

Results Enrolled I nitiated Alive

Of those infants testing HIV positive via EID, attrition post testing is significant (2008 data from multi-country review)

Patients lost

Patients EID tested

Follow up of Infants Testing Positive via EID at Review Sites

0

500

1000

1500

2000

2500

3000

3500

PositivePCR

Results Enrolled I nitiated Alive

3182

2330

EnrolledPositive via EID

Initiated on ART

Rec. Results

Active on ART

1170878

Uganda-72% not alive & on ART

No data

0

25

50

75

100

PositivePCR

Results Enrolled I nitiated Alive

87

EnrolledPositive via EID

InitiatedReceived Results

Alive on ART

2330

4

90

Received Results/ Enrolled

Positive via EID

Initiated on ART

Results at Site

Active on ART

38 33

93

Senegal 67% not alive & on ART

Cambodia- 67% not alive & on ART

No data 6

14

27

100

Infa

nts

Infa

nts

Infa

nts

Less than one half of infants ever tested via EID across four countries were tested in their first two months of life in 2008. Coverage of the optimal service (early testing) was lower

Portion of HIV Exposed Infants in Need Receiving EID Service in First Two Months of Life

Missed early testing

opportunities: PMTCT follow

up appointments,

vaccination schedule

• EID services must integrated into broader package of care and treatment for HIV-exposed infants

• Paradigm shift away from vertical EID programs needed

• Back to Basics: Cotrimoxazole and Infant Feeding• CTX coverage only 8% versus 15% for EID in multi-country reviews!

• Stronger linkages to ART urgently needed• Need to improve organization of services at site-level. SOPs, QI approaches, and case

management.

• Laboratory expansion is not the optimal way in many cases to invest resources to improve outcomes for the end user.

• National programs and partners should consider collection site and testing laboratory expansion carefully versus other investments in ensuring ART initiation occurs.

• Point of care diagnostics urgently needed • But, while we await these, let’s improve the other components of care!

Key Points for Discussion

Thank you!

S Tripathi, C Kiyaga, M Nghatanga, M Chhi Vun, A S Wade, R Gass, A Chatterjee, R Ekpini, C Luo

Please see “ART in Children: Programme Outcomes” Session TUPDB205 on Tuesday for fuller discussion of multi-country EID review.

Agenda