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Challenges in introducing infant diagnosis of HIV using dried blood spots for DNA PCR in primary health care settings
Presented by Isabelle Yersin, Mozambique.
Jani I.1, Langa J.2, Vaz P.3, Bila D.1, Yersin I.2, Oliveira-Tsiouris F.4, da Silva Z.5, Benech I.6
1National Institute of Health, Imunology, Maputo, Mozambique, 2International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University Maputo, Mozambique, PMTCT, Maputo, Mozambique, 3Central Hospital,Maputo, Pediatry, Maputo, Mozambique, 4International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, New York, United States, 5Ministry of Health (MOH), Maputo, Mozambique, Maputo, Mozambique, 6Centers for Disease Control and Prevention (CDC), Maputo, Mozambique, Maputo, Mozambique
Objectives: The Mozambican Prevention-of-Mother-To-Child-Transmission (PMTCT) program recommends follow-up of HIV–exposed children at the ‘at risk child consultation’ (ARCC). Diagnosis of HIV-exposed infants occurred at 18 months. National data show the majority of HIV-exposed children are lost to follow-up before that. Recently, national capacity was created to provide early infant diagnosis (EID) using Polymerase Chain Reaction (PCR) testing of Dried Blood Spot (DBS.
Methods: A working group was created to • develop EID protocol • develop and implement an algorithm for PCR testing of DBS • design a system, between central and provincial laboratories Program implementation began in phases. Phase 1 started in 5 Maputo health centers. PMTCT program managers attended coordination and orientation meetings. National Institute of Health staff conducted a nurse’s training in DBS sample collection.
Results: Preliminary results show high acceptance rates for children tested after counseling mothers. Fingerprick sample collection was feasible and acceptable. More blood samples for PCR testing were collected in one month at Phase I centers than the total number collected for antibody testing in the past year under the old protocol.
Conclusions: Universal training of maternal and child health (MCH) nurses in care of HIV-exposed children should be a goal of PMTCT/ANC programs, in addition to training in HIV testing to increase early identification of HIV-infected children. A comprehensive EID training should also include counseling, disclosure of HIV status, need for follow-up testing, and outreach for children lost to follow-up. Tracking, monitoring and evaluation should be integral components of EID programming.
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