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HIV early infant diagnostic: Opportunity and challenge to prevent mother-to-child transmission of HIV

November 28, 2012

This piece originally appeared on FHI 360's Degrees Blog. For the complete text, please visit: http://degrees.fhi360.org/hiv-early-infant-diagnostic-opportunity-and-challenge-to-prevent-mother-to-child-transmission-of-hiv/.

By Justin Mandala, MD, MPH, FHI 360 Technical Advisor, and Kwasi Torpey, MD, PhD, MPH, Director of Technical Support in FHI 360′s Zambia Prevention Care and Treatment Partnership

Mother-to-child transmission accounts for the majority of pediatric HIV infections.

The last decade has seen significant progress in the implementation of prevention programs. Success has been measured using process indicators, such as the number of pregnant women provided with counseling and testing services. Although these indicators are useful in tracking access and uptake of prevention services, they do not tell us whether our interventions are working. Early infant diagnosis (EID) may be a better tool for measuring our impact.

EID is typically done on babies born to mothers with HIV. Blood from the exposed baby is blotted on a filter paper, which is then couriered to a testing laboratory. The test is able to show as early as six weeks of age whether a baby is infected. This is important for the following reasons:

  1. It allows early identification of babies who do not have HIV and reinforcement of infant feeding counseling to ensure the babies remain HIV negative.
  2. Infants with HIV are rapidly identified and placed on antiretroviral therapy to reduce morbidity and mortality.
  3. It allows objective determination of the effectiveness of prevention efforts, helping us understand what works and what doesn’t.

Determining the effectiveness of prevention efforts allows programs to assess whether efforts to reduce pediatric infection are on track. FHI 360 has invested heavily in developing EID capacity in Ndola, Zambia, and Jalingo, Taraba State in Nigeria. These facilities are located away from the country’s capital and linked to health facilities in both rural and urban centers. Transporting dried blood spot specimens allows far-flung and hard-to-reach facilities to access sophisticated HIV-testing facilities for infants.

In FHI 360 programs in Nigeria and Zambia, EID has been successfully integrated in immunization clinics. This is critical in the provision of integrated maternal, newborn and child health services.

Prevention of mother-to-child transmission programs must incorporate EID into routine indicators. Although important in determining program effectiveness, EID requires good sample collection and storage practices and an efficient courier system. Accurate test results will be crucial as we march toward elimination of mother-to-child transmission.