A novel approach to increase Early Infant Diagnosis of HIV

If you text them, they will come: using the HIV infant tracking system to improve early infant diagnosis quality and retention in Kenya

Finocchario-Kessler S, Gautney BJ, Khamadi S, Okoth V, Goggin K, Spinler JK, Mwangi A, Kimanga D, Clark KF, Olungae HD, Preidis GA, Team HI. AIDS. 2014 Jul;28 Suppl 3:S313-21. doi: 10.1097/QAD.0000000000000332.

Objective: The objective of this study is to evaluate the impact of the HIV Infant Tracking System (HITSystem) for quality improvement of early infant diagnosis (EID) of HIV services.

Design and setting: This observational pilot study compared 12 months of historical pre-intervention EID outcomes at one urban and one peri-urban government hospital in Kenya to 12 months of intervention data to assess retention and time throughout the EID cascade of care.

Participants: Mother-infant pairs enrolled in EID at participating hospitals before (n = 320) and during (n = 523) the HITSystem pilot were eligible to participate.

Intervention: The HITSystem utilizes Internet-based coordination of the multistep PCR cycle, automated alerts to trigger prompt action from providers and laboratory technicians, and text messaging to notify mothers when results are ready or additional action is needed.

Main outcome measures: The main outcome measures were retention throughout EID services, meeting time-sensitive targets and improving results turn-around time, and increasing early antiretroviral therapy (ART) initiation among HIV-infected infants.

Results: The HITSystem was associated with an increase in the proportion of HIV-exposed infants retained in EID care at 9 months postnatal (45.1-93.0% urban; 43.2-94.1% peri-urban), a decrease in turn-around times between sample collection, PCR results and notification of mothers in both settings, and a significant increase in the proportion of HIV-infected infants started on antiretroviral therapy at each hospital (14 vs. 100% urban; 64 vs. 100% peri-urban).

Conclusion: The HITSystem maximizes the use of easily accessible technology to improve the quality and efficiency of EID services in resource-limited settings.

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Editor’s notes: This study, based in Kenya uses a novel approach to improve EID and increase infant initiation of antiretroviral therapy (ART). Despite some limitations (being an observational study and using historical controls), the method not only increased the proportion of HIV-exposed infants retained in care but importantly also reduced turn-around times. Given the near universal access to mobile phones even in low resource settings, these findings are highly encouraging in this challenging area of HIV care delivery. The authors highlight that the novel system which integrates customised alerts (Internet and SMS-based) with dedicated prospective tracking of clients, successfully addresses multiple implementation barriers for the EID cascade of care. They further suggest that HITSystem implementation is feasible in remote areas, as it requires neither a continuous supply of electricity nor wire-based Internet access, provided site mobile broadband can be accessed. Such a system could also be beneficial for other areas of adherence support and further exploration is warranted.

Health care delivery
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