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

Creek, 2008 [3]

Botswana

Dow, IAS 2009 [71]

Malawi

Of 646 HIV-infected mothers, 338 (53%) presented for EID testing

Kimario, HAIM 2009 [62]

Tanzania

Of 2,128 HIV-exposed infants identified, 2,089 (98%) were tested

Leroy, IAS 2009 [81]

Côte d'Ivoire

Of 7,579 eligible, 3,013 (40%) offered EID testing, and 447 accepted (15% of offered, 6% of total)

Rollins, 2009 [68]

South Africa

Of 646 mothers, 584 (90%) agreed to and underwent EID testing

Nuwagaba, 2010 [70]

Tanzania

Of 510 HIV-exposed infants identified, 441 (87%) were tested

Braun, 2011 [110]

Malawi

Of 14,669 HIV-exposed infants identified, 7,875 (54%) were tested

Hassan, 2011 [76]

Kenya

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

Of 9,922 samples, 3 (0.03%) unevaluable due to errors in specimen collection or packaging

Kouakou, IAS 2008 [63]

Côte d'Ivoire

Of 588 specimens, 92 (16%) unevaluable, and an additional 54 (9%) were not evaluated for unspecified reasons

Lofgren, 2009 [28]

Tanzania

Of 223 samples, 27 (12%) 'lost with assay errors' and 7 (3%) specimens hemolyzed or of insufficient quantity

Menzies, 2009 [66]

Uganda

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

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

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

'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