艾滋病毒感染婴儿的出生检测及与护理的衔接

HIV birth testing and linkage to care for HIV-infected infants.

作者信息

Jean-Philippe Patrick, Spiegel Hans, Gnanashanmugam Devasena, Fitzgibbon Joseph, DʼSouza Patricia, Crawford Keith W, Jayashankar Lakshmi, Bacon Melanie C, Essajee Shaffiq M, Aldrovandi Grace M, Cotton Mark, Abrams Elaine J

机构信息

aNational Institute of Allergy and Infectious Diseases, National Institutes of Health bKelly Government Solutions cColumbus Technologies and Services Inc., Contractor to the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA dWHO, Geneva, Switzerland eChildren Hospital of Los Angeles, Los Angeles, California, USA fStellenbosh University, Cape Town, South Africa gColumbia University Mailman School of Public Health, New York City, New York, USA.

出版信息

AIDS. 2017 Aug 24;31(13):1797-1807. doi: 10.1097/QAD.0000000000001561.

Abstract

: On 5-6 May 2016, the division of AIDS of the National Institute of Allergy and Infectious Diseases convened a workshop on 'HIV Birth Testing and Linkage to Care for HIV Infected Infants.' The goal of the workshop was to evaluate birth testing for early infant diagnosis (EID) of HIV, delineate technological resources for advancing a point-of-care (POC) HIV test implementable at birth and chart out the implementation hurdles for initiating early antiretroviral therapy to HIV-infected infants diagnosed at birth. The workshop addressed research and regulatory needs involved in the optimization of POC EID testing and challenges associated with implementation of EID, focusing on testing at birth. Scientific gaps and areas of intervention to accelerate and scale-up EID initiatives and birth testing were identified. These include discussion of the evidence supporting an early mortality peak among HIV-infected infant and justifying a role for birth HIV testing, including POC testing; evaluation of the current POC EID technology pipeline and test performance characteristics required for effective programmatic uptake; mathematical modeling of different testing scenarios and solutions with inclusion of birth testing; the adoption of setting-specific EID testing algorithms to achieve efficient linkage to care including early antiretroviral therapy initiation; the development of appropriate quality assurance programs to ensure accuracy of test results and enable sustainability of the testing program. Addressing these gaps and answering these challenges will be important in helping improve outcomes for HIV-infected infants and accelerate achieving the Joint United Nations Program for HIV and AIDS 90-90-90 targets in children.

摘要

2016年5月5日至6日,美国国立过敏与传染病研究所艾滋病部门召开了一次关于“HIV出生检测及与HIV感染婴儿护理的衔接”的研讨会。该研讨会的目标是评估用于HIV早期婴儿诊断(EID)的出生检测,确定推进可在出生时实施的即时检验(POC)HIV检测的技术资源,并规划对出生时诊断出的HIV感染婴儿启动早期抗逆转录病毒治疗的实施障碍。研讨会讨论了优化POC EID检测所涉及的研究和监管需求以及与EID实施相关的挑战,重点是出生时检测。确定了加速和扩大EID倡议及出生检测的科学差距和干预领域。这些包括讨论支持HIV感染婴儿早期死亡率高峰的证据以及证明出生时HIV检测(包括POC检测)的作用;评估当前POC EID技术流程以及有效纳入项目所需的检测性能特征;对包括出生检测在内的不同检测方案和解决方案进行数学建模;采用针对特定环境的EID检测算法以实现与护理的有效衔接,包括早期抗逆转录病毒治疗的启动;制定适当的质量保证计划以确保检测结果的准确性并使检测项目可持续。解决这些差距并应对这些挑战对于帮助改善HIV感染婴儿的结局以及加速实现联合国艾滋病规划署儿童90-90-90目标至关重要。

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