Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
PLoS One. 2013 Nov 1;8(11):e78891. doi: 10.1371/journal.pone.0078891. eCollection 2013.
There is scant evidence on the association between diagnosis delays and the receipt of test results in HIV Early Infant Diagnosis (EID) programs. We determine the association between diagnosis delays and other health care system and patient factors on result receipt.
We reviewed 703 infant HIV test records for tests performed between January 2008 and February 2009 at a regional referral hospital and level four health center in Uganda. The main outcome was caregiver receipt of the test result. The primary study variable was turnaround time (time between sample collection and result availability at the health facility). Additional variables included clinic entry point, infant age at sample collection, reported HIV status and receipt of antiretroviral prophylaxis for prevention of mother-to-child transmission. We conducted a pooled analysis in addition to separate analyses for each facility. We estimated the relative risk of result receipt using modified Poisson regression with robust standard errors.
Overall, the median result turnaround time, was 38 days. 59% of caregivers received infant test results. Caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days or fewer (ARR = 0.83; 95% CI = 0.70-0.98). Caregivers were more likely to receive results at the PMTCT clinic (ARR = 1.81; 95% CI = 1.40-2.33) and less likely at the pediatric ward (ARR = 0.54; 95% CI = 0.37-0.81) compared to the immunization clinic. At the level four health center, result receipt was half as likely among infants older than 9 months compared to 3 months and younger (ARR= 0.47; 95% CI = 0.25-0.93).
In this study setting, we find evidence that longer turnaround times, clinic entry point and age at sample collection may be associated with receipt of infant HIV test results.
关于艾滋病毒早期婴儿诊断（EID）项目中诊断延迟与检测结果获得之间的关联，证据有限。我们确定了诊断延迟与其他卫生保健系统和患者因素之间的关系，这些因素与结果的获得有关。
我们回顾了 2008 年 1 月至 2009 年 2 月期间在乌干达一家地区转诊医院和四级保健中心进行的 703 例婴儿艾滋病毒检测记录。主要结果是照顾者获得检测结果。主要研究变量是周转时间（从样本采集到实验室获得结果的时间）。其他变量包括就诊点、样本采集时婴儿年龄、报告的艾滋病毒状况和预防母婴传播的抗逆转录病毒预防用药。我们进行了 pooled 分析，以及每个设施的单独分析。我们使用修正后的泊松回归和稳健标准误差来估计结果获得的相对风险。
总体而言，结果周转时间的中位数为 38 天。59%的照顾者收到了婴儿检测结果。与 28 天或更短时间相比，照顾者在周转时间超过 49 天的情况下获得结果的可能性较低（ARR = 0.83；95%CI = 0.70-0.98）。与免疫接种门诊相比，在 PMTCT 门诊（ARR = 1.81；95%CI = 1.40-2.33）就诊的照顾者更有可能获得结果，而在儿科病房（ARR = 0.54；95%CI = 0.37-0.81）就诊的照顾者获得结果的可能性较小。在四级保健中心，9 个月以上婴儿的结果获得率是 3 个月及以下婴儿的一半（ARR= 0.47；95%CI = 0.25-0.93）。
在本研究环境中，我们发现证据表明，较长的周转时间、就诊点和样本采集时的年龄可能与婴儿艾滋病毒检测结果的获得有关。
