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

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Point-of-Care Early Infant Diagnosis Testing and Linkage to Antiretroviral Therapy, Among HIV-Exposed Infants From Two Pediatric Referral Hospitals, Mozambique
Abbreviation: ART, antiretroviral therapy.

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TABLE 1.

Clinical and Demographic Characteristics of HIV-Exposed Infants in Point-of-Care Early Infant Diagnosis Study From Inpatient Wards of 2 Pediatric Referral Hospitals, Mozambique

Variable	Patients, n (%)
Variable	HCB	HCM	Total
Age, months
1–2	101 (30.6)	45 (24.9)	146 (28.6)
3–5	67 (20.3)	54 (29.8)	121 (23.7)
6–8	73 (22.1)	33 (18.2)	106 (20.7)
9–11	40 (12.1)	27 (14.9)	67 (13.1)
≥12	48 (14.5)	20 (11.0)	68 (13.3)
Missing	1 (0.3)	2 (1.1)	3 (0.6)
Sex
Female	148 (44.8)	84 (46.4)	232 (45.4)
Male	182 (55.2)	97 (53.6)	279 (54.6)
Previous DNA PCR
Yes	138 (41.8)	81 (45.0)	219 (42.9)
No^a	192 (58.2)	99 (55.0)	292 (57.1)
Maternal PMTCT
Prophylaxis	2 (0.6)	4 (2.2)	6 (1.2)
Full ART	210 (63.6)	133 (73.5)	343 (67.1)
None	105 (31.8)	31 (17.1)	136 (26.6)
Missing	13 (3.9)	13 (7.2)	26 (5.1)
Infant PMTCT
NVP prophylaxis	207 (62.7)	130 (71.8)	337 (65.9)
None	113 (34.2)	33 (18.2)	146 (28.6)
Missing	10 (3.0)	18 (9.9)	28 (5.5)
Current breastfeeding
Yes	233 (70.6)	93 (51.4)	326 (63.8)
No	78 (23.6)	73 (40.3)	151 (29.5)
Missing	19 (5.8)	15 (8.3)	34 (6.7)
Total	330 (100)	180 (100)	511 (100)

Abbreviations: ART, antiretroviral therapy; HCB, Hospital Central de Beira; HCM, Hospital Central de Maputo; NVP, nevirapine; PCR, polymerase chain reaction; PMTCT, prevention of mother-to-child transmission.
↵a Includes infants with unknown or undocumented previous testing.

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TABLE 2.

Point-of-Care Early Infant Diagnosis Positivity by Clinical and Demographic Variables Among HIV-Exposed Infants From Inpatient Wards of 2 Pediatric Referral Hospitals, Mozambique

Variable	Negative Test, n (%)	Positive Test, n (%)	Chi-Square P Value
Age, months
1–2	113 (77.4)	33 (22.6)	0.127
3–5	77 (63.6)	44 (36.4)
6–8	70 (66.0)	36 (34.0)
9–11	48 (71.6)	19 (28.4)
≥12	49 (72.1)	19 (27.9)
Missing	2 (66.7)	1 (33.3)
Sex
Female	160 (69.0)	72 (31.0)	0.561
Male	199 (71.3)	80 (28.7)	0.561
Previous DNA PCR
Yes	162 (74.0)	57 (26.0)	0.106
No	196 (67.4)	95 (32.6)	0.106
Maternal PMTCT
Prophylaxis	5 (83.3)	1 (16.7)	0.047^a
Full ART	249 (72.6)	94 (27.4)
None	84 (61.8)	52 (38.2)
Missing	21 (80.8)	5 (19.2)
Infant PMTCT
NVP prophylaxis	248 (73.6)	89 (26.4)	0.018
None	92 (63.0)	54 (37.0)
Missing	19 (67.9)	9 (32.1)
Current breastfeeding
Yes	218 (66.9)	108 (33.1)	0.019
No	117 (77.5)	34 (22.5)
Missing	24 (70.6)	10 (29.4)
Total	359 (70.3)	152 (29.7)

Abbreviations: ART, antiretroviral therapy; NVP, nevirapine; PCR, polymerase chain reaction; PMTCT, prevention of mother to child transmission.
↵a Fisher's exact test.

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TABLE 3.

Point-of-Care Early Infant Diagnosis Positivity Among HIV-Exposed Infants From Inpatient Wards of 2 Pediatric Referral Hospitals, Mozambique, by Referral Ward

Ward	Negative Test, n (%)	Positive Test, n (%)	Fisher's Exact Test P Value
Nursery	12 (100.0)	0 (0)	0.002
Breastfeeding^a	108 (61.7)	67 (38.3)
General ward^b	32 (82.1)	7 (17.9)
Infectious diseases	130 (74.7)	44 (25.3)
Malnutrition	33 (58.9)	23 (41.1)
Pediatric intensive care unit	15 (60.0)	10 (40.0)
Other^c	5 (83.3)	1 (16.7)
Missing	24 (100.0)	0 (0)
Total	359 (70.3)	152 (29.7)

↵a Ward for all admission diagnoses in patients aged 1–12 months at Hospital Central de Maputo. During the study, Hospital Central de Beira changed admission criteria to breastfeeding ward from 1–6 months to 1–12 months.
↵b Patients aged 12 months or older.
↵c Includes pediatric surgery, respiratory, and other subspecialty wards.