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Table 1 Recent reports of early infant diagnostic testing programs in resource-limited settings: loss to follow-up at key steps in the 'cascade' of care

From: Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions

First author, year, reference Location Program, population Findings
Proportion of HIV-exposed infants undergoing EID testing:
Creek, 2008 [3] Botswana Pilot EID program: HIV-exposed infants attending well child visits, and inpatient and outpatient care settings Of estimated 1,500 HIV-exposed children attending well child (clinic) visits, 1,297 (86%) were tested (total HIV-exposed no. not estimated for inpatient/outpatient settings)
Dow, IAS 2009 [71] Malawi Infants of known HIV-infected mothers offered EID at 6 weeks of age Of 646 HIV-infected mothers, 338 (53%) presented for EID testing
Kimario, HAIM 2009 [62] Tanzania Ministry of Health-supported EID scale-up program: HIV-exposed infants age 1-9 months Of 2,128 HIV-exposed infants identified, 2,089 (98%) were tested
Leroy, IAS 2009 [81] Côte d'Ivoire EID program: all infants attending immunization or outpatient clinics Of 7,579 eligible, 3,013 (40%) offered EID testing, and 447 accepted (15% of offered, 6% of total)
Rollins, 2009 [68] South Africa All mothers/infants attending immunization clinics at 6, 10, or 14 weeks of age (median 7.7 weeks) Of 646 mothers, 584 (90%) agreed to and underwent EID testing
Nuwagaba, 2010 [70] Tanzania Pilot EID program: HIV-exposed infants identified via maternal status or positive HIV antibody result Of 510 HIV-exposed infants identified, 441 (87%) were tested
Braun, 2011 [110] Malawi Retrospective review of ANC, EID, and pediatric ART programs in Lilongwe, Malawi, 2004-2008 Of 14,669 HIV-exposed infants identified, 7,875 (54%) were tested
Hassan, 2011 [76] Kenya Retrospective review of HIV-exposed infants enrolled in an HIV clinic in Kilifi District, Kenya, 2006-2008 Of 233 HIV-exposed infants enrolled in care, 156 (67%) were tested
Specimen collection and processing:
Creek, 2008 [3] Botswana As above Of 1,931 samples, 27 (1.4%) unevaluable due to labeling errors
Khamadi, 2008 [61] Kenya Pilot EID program: HIV-exposed infants seen at 6 week immunization visit Of 9,922 samples, 3 (0.03%) unevaluable due to errors in specimen collection or packaging
Kouakou, IAS 2008 [63] Côte d'Ivoire Pilot EID program in 25 PMTCT sites in 10 districts: HIV-exposed infants Of 588 specimens, 92 (16%) unevaluable, and an additional 54 (9%) were not evaluated for unspecified reasons
Lofgren, 2009 [28] Tanzania DBS RNA PCR service for remote healthcare facilities Of 223 samples, 27 (12%) 'lost with assay errors' and 7 (3%) specimens hemolyzed or of insufficient quantity
Menzies, 2009 [66] Uganda Pilot EID program: HIV-exposed infants age 6 weeks to 18 months Of 820 samples, 32 (4%) unevaluable due to sample mislabeling, damage or loss or missing/inconsistent data entries
Proportion of EID results returned:
Creek, 2008 [3] Botswana As above Of 930 tests performed at well child (clinic) visits, 753 results (81%) returned to families. Of 38 infants with positive results at all sites, 34 results (90%) returned to families
Chouraya, IAS 2009 [59] Swaziland Pilot EID program: HIV-exposed infants, aged < 12 months, with positive PCR results Of 124 infants with positive PCR results, 22 (18%) started ART before pilot program (result receipt inferred), and 50 (40%) were informed of results via pilot (total = 72 (58%) of 124). Additionally, 11 infants (9%) died before pilot and 41 (33%) were unable to be contacted; result receipt among these infants is unknown.
Kimario, HAIM 2009 [62] Tanzania As above Of 2,089 infants tested, 1,331 results (64%) returned to facilities, and 774 results (37%) returned to families
Leroy, IAS 2009 [81] Cote d'Ivoire As above Of 42 tested infants, 25 (60%) of families returned for results
Rollins, 2009 [68] South Africa As above Of 584 infants tested, 332 mothers (57%) returned for results
Sundaram, IAS 2009 [69] Swaziland Retrospective review of HIV-infected infants diagnosed via DBS PCR at 15 clinical sites Of 176 positive PCR results, 137 results (78%) returned to healthcare facility and 77 results (44%) returned to families
Nuwagaba, 2010 [70] Tanzania As above Of 441 tested infants, 242 (55%) returned for results. Of 75 with positive PCR results, 51 (68%) returned for results; 7 (14%) of these children had died before result receipt. Of 361 with negative PCR results, 187 (52%) returned for results. Of five with indeterminate PCR results, four (80%) returned for results.
Hassan, 2011 [76] Kenya As above Of 156 infants tested, 110 (71%) returned for results.
Time to return of EID results to healthcare facilities or families/caregivers:
Creek, 2008 [3] Botswana As above Specimen collection to results return at healthcare facilities: 9 days
Khamadi, 2008 [61] Kenya As above Specimen collection to result return to families: range, 1-3 months.
Individual components:
Specimen collection to specimen receipt in laboratory: range, 6 hours to 3 weeks.
Specimen receipt in laboratory to result dispatch from laboratory: 2006-2007: median 13.5 days, range 6-20 days; 2008: median 4 days.
Kouakou, IAS 2008 [63] Côte d'Ivoire As above Specimen receipt in laboratory to result return to facilities: 4-8 weeks
Mahdi, IAS 2008 [65] Swaziland EID program and Public Health Unit: HIV-exposed infants aged < 18 months; n = 322 'Average turnaround time': 4-6 weeks
Kimario, HAIM 2009 [62] Tanzania As above 'Turnaround time': 1-3 months
Lofgren, 2009 [28] Tanzania As above Specimen collection to result return to facilities: median 23 days, range 4-69 days (excluding single vacation period responsible for greatest delays: median 17 days, range 4-39 days).
Individual components:
Specimen collection to shipment from facilities: range 0-7 days.
Transit, facilities to laboratories: median 1.5 days, range 1-2 days.
Laboratory processing: median 13 days, range 1-51 days (excluding single vacation period as above: median 7 days, range 1-21 days).
Completion of laboratory processing to shipment of results: range, 0-7 days.
Transit, laboratories to facilities: median 1.5 days, range 1-2 days.
Rollins, 2009 [68] South Africa As above Of 332 families returning for results, 160 (48%) returned at scheduled visit 2 weeks after testing. Of 172 returning at another time, 138 (80%) returned approximately 4 weeks after testing.
Nuwagaba, 2010 [70] Tanzania As above Positive PCR results: median 5 weeks, range < 1-14 weeks.
Negative PCR results: median 10 weeks, range < 1-21 weeks.
Hassan, 2011 [76] Kenya As above 'Waiting time to DBS results': median 1.7 months
Proportion of identified HIV-infected infants linking to HIV care:
Creek, 2008 [3] Botswana As above Of 34 PCR-positive infants receiving results, 22 (65%) were seen in ART clinic
Kimario, HAIM 2009 [62] Tanzania As above Of 190 PCR-positive infants receiving results, 175 (92%) were referred to HIV care and treatment clinic, and 149 (78%) enrolled at clinic
Mahdi, IAS 2008 [65] Swaziland As above Of 19 infants with positive PCR results, 13 (68%) linked to HIV care
Sundaram, IAS 2009 [69] Swaziland As above Of 77 PCR-positive infants receiving results, 58 (75%) enrolled at ART clinic
Nuwagaba, 2010 [70] Tanzania As above Of 52 PCR-positive infants receiving results, 42 (81%) were referred to HIV care (7 of 52 (14%) had died when result was received, and 3 of 52 (6%) died between result receipt and referral)
Braun, 2011 [110] Malawi As above Of 1,084 infants with positive PCR results, 320 (30%) were traced to enrolment in an HIV care and treatment clinic
Proportion of identified HIV-infected infants initiating cotrimoxazole:
Augustinova, IAS 2009 [89] Cambodia Retrospective review of EID among HIV-exposed infants aged < 18 months at PMTCT and pediatric inpatient and outpatient sites Of 37 infants with positive PCR results, 13 (35%) initiated OI prophylaxis; an additional 14 (38%) initiated ART (if OI prophylaxis inferred, total = 27 of 37 (73%))
Proportion of identified HIV-infected infants initiating ART:
Creek, 2008 [3] Botswana As above Of 22 infants enrolled in HIV clinic, 17 (77%) initiated ART. These 17 infants represent 45% of the 38 infants with positive PCR results, and 50% of the 34 infants who received positive PCR results.
Mahdi, IAS 2008 [65] Swaziland As above Of 13 PCR-positive infants linking to care, 5 (38%) initiated ART. These 5 infants represent 26% of the 19 infants with positive PCR results.
Augustinova, IAS 2009 [89] Cambodia As above Of 37 infants with positive PCR results, 14 (38%) initiated ART
Chouraya, IAS 2009 [59] Swaziland As above Of 124 infants with positive PCR results, 22 (18%) initiated ART before pilot. Through EID pilot program, 25 additional infants (20%) received results and initiated ART; total = 47 of 124 (38%).
Additionally, 11 infants (9%) died before the pilot program and 41 (33%) were unable to be contacted through pilot; although unlikely, ART receipt among these infants is unknown.
Kimario, HAIM 2009 [62] Tanzania As above Of 149 PCR-positive infants enrolled in care and treatment clinic, 68 (46%) initiated ART. These 68 infants represent 36% of the 190 results returned to families, and 22% of the 310 results returned to facilities.
Sundaram, IAS 2009 [69] Swaziland As above Of 58 infants enrolled at ART clinic, 34 (59%) initiated ART. These 34 infants represent 19% of the 176 infants with positive PCR results.
Braun, 2011 [110] Malawi As above Of 202 PCR-positive infants enrolled in a care and treatment clinic, 110 (55%) initiated ART at a median 2.5 months after enrollment
  1. ANC = antenatal clinic; ART = antiretroviral therapy; CTX = cotrimoxazole; DBS = dried blood spot; EID = early infant diagnosis; HAIM = President's Emergency Plan for AIDS Relief (PEPFAR)-sponsored HIV/AIDS Implementers Meeting; IAS = International AIDS Society Conference; OI = opportunistic infection.