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Effect of point-of-care early infant diagnosis on antiretroviral therapy initiation and retention of patients: a cluster-randomised trial

Jani, Ilesh V.a; Meggi, Bindiyaa; Loquiha, Osvaldoc; Tobaiwa, Oceanb; Mudenyanga, Chishamisob; Zitha, Alcinaa; Mutsaka, Dadirayia; Mabunda, Nedioa; Vubil, Adolfoa; Bollinger, Timothyb; Vojnov, Larab; Peter, Trevor F.b

doi: 10.1097/QAD.0000000000001846
ORIGINAL ARTICLE: PDF Only

Objective: We measured the effect of point-of-care early infant HIV testing on antiretroviral therapy initiation rates and retention in care among infants in Mozambique.

Design: A cluster-randomised trial was conducted in 16 primary health care centres providing either on-site point-of-care (POC arm; n = 8) or referred laboratory (SOC arm; n = 8) infant HIV testing.

Methods: The primary outcomes were the proportion of HIV-positive infants initiating antiretroviral therapy within 60 days of sample collection, and the proportion of HIV-positive infants who initiated antiretroviral therapy that were retained in care at 90 days of follow-up.

Results: The proportion of HIV-positive infants initiating antiretroviral therapy within 60 days of sample collection was 89.7% (157 of 175) for the POC arm and 12.8% (13 of 102) for the SOC arm (RR(adj) 7.34; p < 0.001). The proportion of HIV-positive infants who initiated antiretroviral therapy that were retained in care at 90 days of follow-up was 61.6% (101 of 164) for the POC arm and 42.9% (21 of 49) for the SOC arm (RR(adj) 1.40; p < 0.027). The median time from sample collection to antiretroviral therapy initiation was less than one day (interquartile range: 0–1) for the POC arm and 127 days (44–154; p < 0.001) for the SOC arm.

Conclusions: Point-of-care infant HIV testing enabled clinics to more rapidly diagnose and provide treatment to HIV-infected infants. This reduced opportunities for pre-treatment loss to follow-up and enabled a larger proportion of infants to receive test results and initiate antiretroviral therapy. The benefits of faster HIV diagnosis and antiretroviral treatment may also improve early retention in care.

Funding: The funders of the study had no role in study design, data collection, data analysis, data interpretation and writing of the report.

aInstituto Nacional de Saúde, Maputo, Mozambique

bClinton Health Access Initiative, Maputo, Mozambique

cDepartment of Mathematics and Informatics, Universidade Eduardo Mondlane, Maputo, Mozambique.

Correspondence to Ilesh V. Jani, MD PhD, Instituto Nacional de Saúde, Av. Eduardo Mondlane 1008, 2nd floor, Maputo, Mozambique e-mail: ilesh.jani@gmail.com

Received 28 November, 2017

Revised 21 February, 2018

Accepted 17 March, 2018

Sources of support: UNITAID, UNICEF, Government of Flanders

Copyright © 2018 Wolters Kluwer Health, Inc.