BACKGROUND:Early infant diagnosis is important for timely identification of HIV-infected infants and linkage to care. Testing at birth has been implemented to facilitate earlier diagnosis of HIV infection but may present new challenges. This study was conducted to understand the acceptability and feasibility of birth testing in urban and rural settings in southern Zambia. METHODS:This cross-sectional study was conducted at 11 hospitals and clinics in Livingstone, Choma, and Macha in Southern Province, Zambia from 2016 to 2018. Infants born to pregnant women living with HIV at the sites were eligible for enrollment. After enrollment, a questionnaire was administered to the mother and a dried blood spot card was collected from infants for testing at a central laboratory. When results were available, mothers were notified to return to the clinic. Acceptability of birth testing was evaluated based on the proportion of women who agreed to participate and the reasons for non-participation among women who declined. Feasibility of testing at birth was evaluated using turnaround times for returning results, the proportion of women receiving results, and linkage to care for infants testing positive. RESULTS:One thousand four hundred three women were approached for the study. A small proportion declined due to refusal of birth testing (0 to 8.2% across sites). One thousand two hundred ninety women agreed to have their infants tested. The proportion of mothers receiving results ranged from 51.6 to 92.1%, and was significantly lower at the hospital than clinics in Livingstone (51.6% vs. 69.8%; p < 0.0001) and Macha (69.5% vs. 85.7%; p < 0.0001) but not Choma (85.7% vs. 92.1%; p = 0.34). For mothers who received test results, the median turnaround time from sample collection was 67 days in Livingstone and 53 days in Macha and Choma. Overall, 23 (1.8%) infants tested positive for HIV but only 8 (34.8%) were linked to care a median of 68 days (range: 29, 784) after sample collection. CONCLUSIONS:While testing at birth was acceptable, this study highlights the operational challenges under a centralized laboratory testing system. Point-of-care platforms are needed for rapid testing and return of results so HIV-infected children can be identified, linked to care, and treated as early as possible.

译文

背景:早期婴儿诊断对于及时识别感染了艾滋病毒的婴儿以及与护理的联系非常重要。已经进行了出生时检测,以促进早期诊断HIV感染,但可能带来新的挑战。进行这项研究是为了了解赞比亚南部城市和农村地区出生测试的可接受性和可行性。
方法:这项横断面研究于2016年至2018年在赞比亚南部省利文斯通,乔马和马查的11家医院和诊所进行。在这些地点感染艾滋病毒的孕妇所生的婴儿符合入组条件。入选后,向母亲进行了问卷调查,并从婴儿那里收集了一张干血点卡以在中央实验室进行测试。当结果可用时,通知母亲返回诊所。根据同意参加试验的妇女比例和拒绝参加试验的妇女拒绝参加试验的原因,对出生测试的可接受性进行了评估。使用返回结果的周转时间,接受结果的妇女比例以及对测试呈阳性的婴儿的护理联系来评估出生时进行测试的可行性。
结果:有143位女性被纳入研究。一小部分由于拒绝出生测试而下降(在各个站点中为0到8.2%)。 129名妇女同意对婴儿进行检查。接受检查的母亲所占比例在51.6%至92.1%之间,并且在医院中显着低于利文斯通(51.6%对69.8%; p <0.0001)和Macha(69.5%对85.7%; p <0.0001)的诊所。但不是Choma(85.7%对92.1%; p = 0.34)。对于收到测试结果的母亲,在利文斯通(Livingstone)收集样本的中位周转时间为67天,在玛莎(Macha)和乔马(Choma)为53天。总体上,有23名(1.8%)婴儿的HIV检测呈阳性,但只有8名(34.8%)的婴儿在收集样本后的中位护理时间为68天(29、784天)。
结论:虽然出生时的测试是可以接受的,但这项研究强调了集中实验室测试系统下的操作挑战。快速检测和返回结果需要现场护理平台,以便可以识别,感染艾滋病毒的儿童,并与他们建立联系,并尽早对其进行治疗。

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