The NSEBA Demonstration Project: implementation of a point-of-care platform for early infant diagnosis of HIV in rural Zambia

Catherine G. Sutcliffe, Nkumbula Moyo, Jessica L. Schue, Jane N. Mutanga, Mutinta Hamahuwa, Passwell Munachoonga, Sylvia Maunga, Philip E Thuma, William J. Moss

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To describe the experience and resource requirements of implementing point-of-care testing for early infant diagnosis of HIV in rural Zambia. Methods: A demonstration project was conducted using a hub-and-spoke model in 2018–2019 at five clinics in rural Zambia. Two testing hubs were established, and all HIV-exposed infants were tested with the GeneXpert system. Data on costs, turnaround times and test results were collected. Results: Seven hundred and eighty six tests were conducted. At the hubs, results were available a median of 2.4 (IQR: 2.1, 2.8) hours after sample collection and most mothers (84%) received same-day results. At the spoke facilities, results were available a median of 9 days (IQR: 7, 12) after sample collection and provided to the mother a median of 16 days (IQR: 10, 28) after sample collection. Eleven children tested positive, and 9 (82%) started treatment a median of 13 days (IQR: 7, 21) after sample collection and on the day mothers received results. In contrast, results from matching samples sent for routine testing were available a median of 38 days (IQR: 27, 61) after sample collection and provided to the mother a median of 91 days (IQR: 47, 135) after sample collection. Conclusions: Implementing point-of-care testing in a network of rural health centres in Zambia required significant initial and ongoing investment in infrastructure, training and supervision. However, point-of-care testing can rapidly diagnose HIV-infected infants, so they can benefit from early treatment.

Original languageEnglish (US)
Pages (from-to)1036-1046
Number of pages11
JournalTropical Medicine and International Health
Volume26
Issue number9
DOIs
StatePublished - Sep 2021

Keywords

  • HIV
  • early infant diagnosis
  • paediatrics
  • point-of-care testing
  • rural health services
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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