Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy

Mércia Matsinhe; Timothy Bollinger; Nilza Lee; Osvaldo Loquiha; Bindiya Meggi; Nédio Mabunda; Chishamiso Mudenyanga; Dadirayi Mutsaka; Marcelina Florêncio; Aurora Mucaringua; Eugénia Macassa; Amir Seni; Ilesh Jani; W. Chris Buck

doi:10.9745/GHSP-D-20-00611

Key Findings

Monthly virologic testing volume in HIV-exposed infants increased 97% with introduction of point-of-care early infant diagnosis testing.
There was a 29.7% positivity rate for inpatient point-of-care tests performed.
Antiretroviral therapy initiation for infants with positive tests improved 64% with introduction of point-of-care early infant diagnosis.

Key Implications

Pediatric inpatient wards are high-yield sites for HIV case identification, and inpatient early infant diagnosis is an important backstop to outpatient follow-up of exposed infants for prevention of mother-to-child transmission.
Point-of-care testing improves inpatient early infant diagnosis performance, facilitating more timely initiation of antiretroviral in HIV-infected infants, and point-of-care early infant diagnosis expansion plans should prioritize high-volume pediatric wards.

ABSTRACT

Introduction:

Novel approaches to case identification and linkage to antiretroviral therapy (ART) are needed to close gaps in early infant diagnosis (EID) of HIV. Point-of-care (POC) EID is a recent innovation that eliminates the long turnaround times of conventional EID that limit patient management in the inpatient setting. The initial deployment of POC EID in Mozambique focused primarily on outpatient clinics; however, 2 high-volume tier-4 pediatric referral hospitals were also included.

Methods:

To assess the impact of inpatient POC EID, a retrospective review of testing and care data from Hospital Central de Beira (HCB) and Hospital Central de Maputo (HCM) was performed for the period September 2017 to July 2018, with comparison to the 8-month pre-POC period when dried blood spots were used for conventional EID.

Results:

Monthly testing volume increased from 8.5 tests pre-POC to 17.6 tests with POC (P<.001). Among 511 children with POC testing, the median age was 5 months, there was ongoing breastfeeding in 326 (63.8%), and 136 (26.6%) of mothers and 146 (28.6%) of infants had not received ART or antiretroviral prophylaxis, respectively. POC tests were positive in 152 (29.7%) infants, and 52 (37.5%) had a previous negative DNA polymerase chain reaction through the conventional outpatient EID program. Linkage to ART for infants with HIV-positive tests improved 64% during the POC period (P=.002). Inpatient mortality for infected infants during the POC period was 28.2%. Excluding these deaths, 61.2% of eligible infants initiated ART as inpatients, but only 29.8% of those discharged without ART were confirmed to have initiated as outpatients.

Conclusions:

Inpatient wards are a high-yield site for EID and ART initiation that have historically been overlooked in programming for prevention of mother-to-child transmission. POC platforms represent a transformative opportunity to increase inpatient testing, make definitive diagnoses, and improve timely linkage to ART. Scale-up plans should prioritize pediatric wards.

Received: October 8, 2020.
Accepted: February 2, 2021.
Published: March 31, 2021.

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