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尼日利亚中北部农村地区婴儿 HIV 早期诊断错失机会：来自 INSPIRE MoMent 研究的级联分析。

Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study.

机构信息

International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria.

Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.

出版信息

PLoS One. 2019 Jul 31;14(7):e0220616. doi: 10.1371/journal.pone.0220616. eCollection 2019.

DOI:10.1371/journal.pone.0220616
PMID:31365571
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6668908/
Abstract

BACKGROUND: Early identification of HIV-infected infants for treatment is critical for survival. Efficient uptake of early infant diagnosis (EID) requires timely presentation of HIV-exposed infants, same-day sample collection, and prompt release of results. The MoMent (Mother Mentor) Nigeria study investigated the impact of structured peer support on EID presentation and maternal retention. This cascade analysis highlights missed opportunities for EID and infant treatment initiation during the study. METHODS: HIV-infected pregnant women and their infants were recruited at 20 rural Primary Healthcare Centers. Routine infant HIV DNA PCR testing was performed at centralized laboratories using dried blood spot (DBS) samples ideally collected by age two months. EID outcomes data were abstracted from study case report forms and facility registers. Descriptive statistics summarized gaps and missed opportunities in the EID cascade. RESULTS: Out of 497 women enrolled, delivery data was available for 445 (90.8%), to whom 415 of 455 (91.2%) infants were live-born. Out of 408 live-born infants with available data, 341 (83.6%) presented for DBS sampling at least once. Only 75.4% (257/341) were sampled, with 81.7% (210/257) sampled at first presentation. Only 199/257 (77.4%) sampled infants had results available up to 28 months post-collection. Two (1.0%) of the 199 infants tested HIV-positive; one infant died before treatment initiation and the other was lost to follow-up. CONCLUSIONS: While nearly 85% of infants presented for sampling, there were multiple missed opportunities, largely due to health system and not necessarily patient-level failures. These included infants presenting without being sampled, presenting multiple times before samples were collected, and getting sampled but results not forthcoming. Finally, neither of the two HIV-positive infants were linked to treatment within the follow-up period, which may have led to the death of one. To facilitate patient compliance and HIV-free infant survival, quality improvement approaches should be optimized for EID commodity availability, consistent DBS sample collection, efficient processing/result release, and prompt infant treatment initiation.

摘要

背景：早期发现感染艾滋病毒的婴儿并进行治疗对于他们的存活至关重要。高效地开展婴儿早期诊断（EID）需要及时将艾滋病毒暴露婴儿带到医疗机构，进行当天的样本采集，并迅速发布检测结果。MoMent（母亲导师）尼日利亚研究调查了结构化同伴支持对 EID 呈现和母婴保留的影响。这一级联分析强调了在研究期间错过 EID 和婴儿治疗启动的机会。

方法：在 20 个农村初级保健中心招募了感染艾滋病毒的孕妇及其婴儿。在中央实验室使用干血斑（DBS）样本对婴儿进行常规 HIV DNA PCR 检测，理想情况下应在两个月龄内采集。EID 结果数据从研究病例报告表和医疗机构登记册中提取。描述性统计分析总结了 EID 级联中的差距和错失的机会。

结果：在 497 名入组的妇女中，有 445 名（90.8%）提供了分娩数据，其中 455 名（91.2%）活产婴儿中有 415 名。在有可用数据的 408 名活产婴儿中，有 341 名（83.6%）至少接受过一次 DBS 采样。只有 75.4%（257/341）接受了采样，其中 81.7%（210/257）在首次就诊时接受了采样。只有 199/257（77.4%）接受采样的婴儿在采集后 28 个月内获得了结果。257 名接受采样的婴儿中只有 2 名（1.0%）HIV 检测呈阳性；其中一名婴儿在开始治疗前死亡，另一名婴儿失访。

结论：虽然近 85%的婴儿接受了采样，但仍存在多次错失机会，这主要是由于卫生系统而不是患者层面的失败。这些机会包括未采样就就诊的婴儿、多次就诊才采集到样本的婴儿、以及接受了采样但未获得结果的婴儿。最后，两名 HIV 阳性婴儿均未在随访期间被转介到治疗中，这可能导致其中一名婴儿死亡。为了促进患者的依从性和 HIV 阴性婴儿的存活，应优化 EID 商品供应、持续的 DBS 样本采集、高效的处理/结果发布以及及时开始婴儿治疗等方面的质量改进措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073c/6668908/9e1e00fd7bad/pone.0220616.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073c/6668908/c92c4e037504/pone.0220616.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073c/6668908/91c33bc931e2/pone.0220616.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073c/6668908/9e1e00fd7bad/pone.0220616.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073c/6668908/c92c4e037504/pone.0220616.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073c/6668908/91c33bc931e2/pone.0220616.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073c/6668908/9e1e00fd7bad/pone.0220616.g003.jpg

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本文引用的文献

[1]
Innovations and challenges in early infant diagnosis of HIV.

Curr Opin HIV AIDS. 2019-1

[2]
Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study.

BMC Pregnancy Childbirth. 2017-7-14

[3]
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HIV birth testing and linkage to care for HIV-infected infants.

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J Acquir Immune Defic Syndr. 2017-6-1

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The Impact of Structured Mentor Mother Programs on Presentation for Early Infant Diagnosis Testing in Rural North-Central Nigeria: A Prospective Paired Cohort Study.

J Acquir Immune Defic Syndr. 2017-6-1

[7]
The Impact of Structured Mentor Mother Programs on 6-Month Postpartum Retention and Viral Suppression among HIV-Positive Women in Rural Nigeria: A Prospective Paired Cohort Study.

J Acquir Immune Defic Syndr. 2017-6-1

[8]
Uptake and performance of prevention of mother-to-child transmission and early infant diagnosis in pregnant HIV-infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia.

Trop Med Int Health. 2017-6

[9]
Scale-up of Early Infant HIV Diagnosis and Improving Access to Pediatric HIV Care in Global Plan Countries: Past and Future Perspectives.

J Acquir Immune Defic Syndr. 2017-5-1

[10]
Using the PMTCT Cascade to Accelerate Achievement of the Global Plan Goals.

J Acquir Immune Defic Syndr. 2017-5-1

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