Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Glob Health Sci Pract. 2022 Jun 29;10(3). doi: 10.9745/GHSP-D-21-00723.
Delayed HIV diagnosis in HIV-exposed infants (HEIs) results in missed opportunities for early antiretroviral therapy (ART), causing significant morbidity and mortality. Early infant diagnosis (EID) depends on the availability of accessible and reliable testing services. We explored the acceptability, appropriateness, and feasibility of deploying a targeted community-based point-of-care (POC) EID testing model (i.e., "community POC model") to reach high-risk mother-infant pairs (MIPs) in Lusaka, Zambia.
We conducted in-depth interviews with a purposive sample of health care workers, study staff, and caregivers in high-risk MIPs at 6 health facilities included in a larger implementation research study evaluating the community POC model. We defined "high-risk MIPs" as mothers who did not receive antenatal testing or an attended delivery or infants who missed EID testing milestones. Interviews were audio-recorded, translated, and transcribed verbatim in English. Content and thematic analysis were done using NVivo 10 software.
Health care workers (n=20) and study staff (n=12) who implemented the community POC model noted that the portability and on-screen prompts of the POC platform made it mobile and easy to use, but maintenance and supply chain management were key to field operations. Respondents also felt that the community POC model reached more infants who had never had EID testing, allowing them to find infants with HIV infection and immediately initiate them on ART. Caregivers (n=22) found the community POC model acceptable, provided that privacy could be ensured because the service was convenient and delivered close to home.
We demonstrate the acceptability, appropriateness, and feasibility of implementing the community POC model in Zambia, while identifying potential challenges related to client privacy and platform field operations. The community POC model may represent a promising strategy to further facilitate active HIV case finding and linkage to ART for children with undiagnosed HIV infection in the community.
艾滋病毒暴露婴儿（HEI）的艾滋病毒诊断延迟导致错失早期抗逆转录病毒治疗（ART）的机会，从而导致严重的发病率和死亡率。早期婴儿诊断（EID）取决于是否提供可及和可靠的检测服务。我们探索了在赞比亚卢萨卡实施以目标人群为基础的即时检测（POC）的社区 EID 检测模型（即“社区 POC 模型”）的可接受性、适当性和可行性，以接触高风险母婴对（MIP）。
我们对 6 家卫生保健机构纳入的更大规模实施研究中评估社区 POC 模型的高风险 MIP 中的卫生保健工作者、研究人员和照顾者进行了深入访谈。我们将“高风险 MIP”定义为未接受产前检测或未进行分娩或错过 EID 检测里程碑的母亲和婴儿。访谈以英语进行了录音、翻译和逐字记录。使用 NVivo 10 软件进行内容和主题分析。
实施社区 POC 模型的卫生保健工作者（n=20）和研究人员（n=12）注意到 POC 平台的便携性和屏幕提示使它具有移动性和易用性，但维护和供应链管理是现场操作的关键。受访者还认为，社区 POC 模型接触到了更多从未接受过 EID 检测的婴儿，使他们能够发现感染艾滋病毒的婴儿，并立即为他们启动 ART。照顾者（n=22）认为社区 POC 模型是可以接受的，前提是可以确保隐私，因为该服务方便且离家近。
我们证明了在赞比亚实施社区 POC 模型的可接受性、适当性和可行性，同时确定了与客户隐私和平台现场操作相关的潜在挑战。社区 POC 模型可能是在社区中进一步促进主动发现艾滋病毒病例并将其与未确诊艾滋病毒感染儿童的 ART 联系起来的有前途的策略。
