Dunning Lorna, Hsiao Nei-yuan, Myer Landon
Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
Division of Medical Virology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa.
J Int AIDS Soc. 2015 Sep 4;18(1):20235. doi: 10.7448/IAS.18.1.20235. eCollection 2015.
Despite improvements in PMTCT services in low- and middle-income countries, there are still almost 200,000 new paediatric HIV infections annually in sub-Saharan Africa. This has led to early infant HIV diagnosis (EID) programmes becoming a public health priority, but until recently, EID has required specialist laboratory equipment and trained personnel which is only feasible in urban, centralized facilities. It is thought that the successful implementation of a point-of-care (POC) test for EID has the potential to increase access to virological tests and address some of the barriers regarding retention of infants in care. However, POC evaluation has not integrated focus on performance characteristics with the health systems issues surrounding the adoption of and optimum use of these new technologies. We propose that moderate improvements in linkage to care can more than offset suboptimal sensitivity of a POC EID test which could be critical in adjusting the focus for EID programme management away from test performance and towards their ability to facilitate successful linkage to antiretroviral therapy (ART) services. These findings also highlight the urgent need to explore the implementation and operational aspects of emerging POC tests in order to fully realize the potential benefits of new technologies in practice.
尽管低收入和中等收入国家的预防母婴传播服务有所改善，但撒哈拉以南非洲每年仍有近20万例新的儿童艾滋病毒感染病例。这使得早期婴儿艾滋病毒诊断（EID）项目成为公共卫生的重点，但直到最近，EID还需要专业的实验室设备和经过培训的人员，这只有在城市的集中设施中才可行。人们认为，成功实施用于EID的即时检测（POC）有可能增加病毒学检测的可及性，并解决一些关于婴儿持续接受护理的障碍。然而，POC评估并未将对性能特征的关注与围绕采用和最佳使用这些新技术的卫生系统问题结合起来。我们建议，在与护理的联系方面适度改善，可以抵消POC EID检测次优敏感性的影响，这对于调整EID项目管理的重点至关重要，即从检测性能转向其促进成功与抗逆转录病毒治疗（ART）服务建立联系的能力。这些发现还凸显了迫切需要探索新兴POC检测的实施和操作方面，以便在实践中充分实现新技术的潜在益处。
