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Piloting very early infant diagnosis (VEID) of HIV in Lesotho: acceptability and feasibility among mothers, health workers and laboratory personnel
Abstract Content:
Background: Mortality
associated with in-utero HIV
infection rises rapidly within weeks after birth. Current guidelines recommend
HIV testing at age six weeks, but very early infant diagnosis (VEID) - testing
at birth-two weeks - followed by immediate initiation of antiretroviral therapy
(ART) has potential to avert mortality associated with in-utero transmission. However, our understanding of acceptability
and feasibility of VEID among mothers, health workers (HW) and laboratory staff
is limited.
Methods: VEID was piloted in an observational prospective cohort of HIV-positive pregnant women and their infants in 13 Lesotho health facilities from July 2014 to October 2016. Semi-structured interviews were conducted March-July 2016 with 20 HIV-positive women attending 6-week or 14-week postnatal visits in eight study facilities in three districts. Counselors/study nurses (n=18) and district/central laboratory staff (n=9) involved in VEID were also interviewed. Interview themes included acceptability of birth and subsequent HIV testing and early treatment, perceived VEID challenges and HIV birth testing procedures and how well they were performed. Thematic analysis was conducted using MAXqda (V10).
Results: Nearly all mothers interviewed were happy to know their child''s HIV status at birth. Mothers and HW did not indicate that birth testing affected subsequent acceptance of infant HIV testing or clinic attendance. No respondents expressed a challenge with early ART initiation (though only the perspective of HW was captured, as all mothers interviewed had HIV-negative children). Some women expressed concern about obtaining blood from newborns and stated they received limited counseling about HIV testing. HW and laboratory staff reported weak follow-up systems for mothers with home delivery, and concern regarding limited number of diagnostic machines, reagent stock-outs and increased workload associated with additional testing requirements. All groups reported turnaround time delays for all EID, and that sometimes results were never received, which would be exacerbated by adding a test to the algorithm.
Conclusions: While respondents found VEID acceptable and feasible, the study also highlighted challenges within the existing EID system that must be addressed for birth testing to be effective. These include strategies to strengthen counseling on infant HIV testing, improve turnaround time, increase the number of facility-based deliveries and improve client tracing procedures.
Methods: VEID was piloted in an observational prospective cohort of HIV-positive pregnant women and their infants in 13 Lesotho health facilities from July 2014 to October 2016. Semi-structured interviews were conducted March-July 2016 with 20 HIV-positive women attending 6-week or 14-week postnatal visits in eight study facilities in three districts. Counselors/study nurses (n=18) and district/central laboratory staff (n=9) involved in VEID were also interviewed. Interview themes included acceptability of birth and subsequent HIV testing and early treatment, perceived VEID challenges and HIV birth testing procedures and how well they were performed. Thematic analysis was conducted using MAXqda (V10).
Results: Nearly all mothers interviewed were happy to know their child''s HIV status at birth. Mothers and HW did not indicate that birth testing affected subsequent acceptance of infant HIV testing or clinic attendance. No respondents expressed a challenge with early ART initiation (though only the perspective of HW was captured, as all mothers interviewed had HIV-negative children). Some women expressed concern about obtaining blood from newborns and stated they received limited counseling about HIV testing. HW and laboratory staff reported weak follow-up systems for mothers with home delivery, and concern regarding limited number of diagnostic machines, reagent stock-outs and increased workload associated with additional testing requirements. All groups reported turnaround time delays for all EID, and that sometimes results were never received, which would be exacerbated by adding a test to the algorithm.
Conclusions: While respondents found VEID acceptable and feasible, the study also highlighted challenges within the existing EID system that must be addressed for birth testing to be effective. These include strategies to strengthen counseling on infant HIV testing, improve turnaround time, increase the number of facility-based deliveries and improve client tracing procedures.