Regular assessments of the competency of POC EID device operators are crucial for ensuring the quality of the testing procedure at an individual level, and can also serve as a key component of a POC EID quality assurance (QA) scheme.
Author: EGPAF
Year: 2019
Expanding access to POC early infant diagnosis: Implementation approaches and testing strategies
Susceptible de changer la donne en matière de traitement pédiatrique du VIH, le dépistage précoce du nourrisson (DPN) sur le lieu de soins est une approche innovante visant à renforcer les programmes de DPN et il améliore les résultats en matière de santé pour les enfants les plus jeunes et les plus vulnérables.
A game changer for paediatric HIV, point-of-care early infant diagnosis (POC EID) is an innovative approach to strengthen EID programs, and improve health outcomes for the youngest and most vulnerable children.
Paediatric HIV treatment coverage is stagnating. The most recent estimates suggest that only 46% of children living with HIV are on treatment, well below the AIDS Free target of 1.6 million by the end of 2018. A key challenge is to identify children who are living with HIV that have been missed through routine testing services.
For children in the 0-14 year age group, over 95% of HIV infections are acquired as a result of vertical transmission. As a result, historical approaches to pediatric diagnosis have tended to focus on early infant diagnosis (EID) within the context of prevention of mother-to-child-transmission (PMTCT) programs.
Testing the family of adult or child ‘index’ cases can serve as an entry point for identification of children living with HIV not identified through PMTCT program
testing. This type of family-based approach to HIV testing and service delivery enables parents and their children to access care as a unit. Such approaches may improve retention and offer a convenient service for families affected by HIV.
This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.
Despite remarkable progress in prevention of mother-to-child transmission of HIV (PMTCT), 160,000 children were newly infected with HIV in 2016. Less than half of HIV-exposed infants (HEI) received early infant diagnosis (EID) within 6 weeks of life, a major challenge for early antiretroviral therapy for HIV-positive infants. Although introduction of dried blood spot (DBS) has increased EID access, conventional laboratory networks have relatively long (22-60 days) turnaround time, resulting in low proportions of results returned and missed opportunities for ART initiation. The WHO conditionally recommends introduction of point-of-care (POC)/ near-POC nucleic acid testing (NAT) for EID.
Recent encouraging evidence for POC/ near-POC EID warrants consideration of rapid adoption and strategic scale-up of this solution complementing the existing laboratory network.
This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.
CDC-Atlanta Maternal Child HIV Branch and International Lab Branch, in collaboration with partners, have developed tools to support health care workers and laboratorians to provide services to HIV-exposed infants, including infant virologic testing.
DBS Job Aids for the Laboratory: DBS receiving, storage, and acceptance criteria
Intended Audience:
Laboratorians who receive dried blood spot specimens.
Summary:
These are job aids that provide basic information for laboratorians about how to receive, process and store DBS specimens. These job aids apply to DBS specimens that are collected for EID, Viral load or drug resistance testing. They may be displayed on the wall in the laboratory for easy reference.
CDC-Atlanta Maternal Child HIV Branch and International Lab Branch, in collaboration with partners, have developed tools to support health care workers and laboratorians to provide services to HIV-exposed infants, including infant virologic testing.
DBS Job Aids for the Clinic: DBS collection, drying, and packaging
Intended audience:
Health care workers who collect specimens for EID on dried blood spots, dry and package specimens for transport.
Summary:
These are visual job aids that are a simplified version of the content provided in the EID video. They cover DBS collection, drying and packaging in the health clinic. They may be displayed on the wall in a health centre for easy reference.
CDC-Atlanta Maternal Child HIV Branch and International Lab Branch, in collaboration with partners, have developed tools to support health care workers and laboratorians to provide services to HIV-exposed infants, including infant virologic testing.
Care of the HIV-Exposed Infant Flipchart
Intended audience:
Health care workers or lay health workers who counsel the caregivers of HEIs.
Summary:
The purpose of this flipchart is to facilitate comprehensive, high quality counseling about the care needs of mothers and HIV-exposed infants to prevent vertical HIV transmission and improve infant health. The flipchart addresses the importance of maternal health and ART adherence, as well as care and testing for the HIV-exposed infant until the infant’s final HIV diagnosis after the end of breastfeeding.
This flipchart should be printed in large format (A3 or similar), spiral bound and laminated for durable use in health clinics. There are 12 counseling cards total – each card has one side with images for the mother/caregiver and the other side with notes for the counsellor.
Topics include: basics of vertical HIV transmission, maternal health during pregnancy and breastfeeding, safe delivery, infant testing, infant medications – cotrimoxazole and ARV prophylaxis, routine infant care -- growth monitoring and immunizations, infant feeding, family planning, signs of acute child illness, and planning for mother and infant follow up.
In follow-up to the 2017 Continental Summit in October 2017, Pediatric-Adolescent Treatment Africa (PATA) released a summary report with key highlights and recommendations from the meeting. Towards an AIDS Free Africa – Delivering on the frontline was the focus of the 2017 Summit, which brought together over 200 delegates across 15 sub-Saharan African countries along with programme implementers and policy-makers from across the globe. The recommendations provided are centred around three pillars – FIND, TREAT and CARE – that support the UNAIDS superfast-track framework. Attending health facility teams drafted new quality improvement plans and will be commencing 53 projects improving service delivery at the frontline in 2018.