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Agenda

Agenda. Increasing Uptake of HIV Early Infant Diagnosis (EID) Services in Four Countries (Cambodia, Namibia, Senegal & Uganda) 20 July 2010, Vienna S Tripathi, Matt Barnhart, C Kiyaga, M Nghatanga, M Chhi Vun, A S Wade, R Gass, A Chatterjee, R Ekpini, C Luo. Context for EID.

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Agenda

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  1. Agenda Increasing Uptake of HIV Early Infant Diagnosis (EID) Services in Four Countries(Cambodia, Namibia, Senegal & Uganda)20 July 2010, Vienna S Tripathi, Matt Barnhart, C Kiyaga, M Nghatanga, M Chhi Vun, A S Wade, R Gass, A Chatterjee, R Ekpini, C Luo

  2. Context for EID Infants and young children are dramatically underrepresented in PMTCT and pediatric HIV services. However, a momentum of policy, technology, and programming hope to close the gap Clear Data Without access to treatment, >33% of HIV positive infants die before the end of their first year of life, and 50% in the first two years of life Strong Policy Guidance Guidance recently released regarding: (1) stronger post natal follow up, (2) importance of EID testing and (3) immediate initiation on ART for HIV positive infants <12m Dramatic Gaps Remain Though 90% of children living with HIV acquired HIV by vertical transmission, few infants and young children access testing and care early in their lives; many die without accessing HIV care1 Tools to close the gap are available Early Infant Diagnosis for HIV (via virologic testing) linked with infant treatment are essential for the survival of HIV exposed infants • Only 15% of HIV exposed infants in low and middle income countries accessed EID testing in their first two months of life in 2008.

  3. Opportunities for Improvement in EID Objective: Review program scale up of EID within the context of exposed infant services across a diverse group of low and middle income countries to understand bottlenecks and lessons learned from service delivery, as well as the impact of EID service Countries Reviewed: Four Ministries of Health led EID service reviews with technical support from UNICEF • Senegal Cambodia • Namibia Uganda Methods/Approach: Review a selection of 18-25 EID collection sites per country spanning geographic, health center level, HIV service availability and time since starting EID metrics Reviewed transport and central laboratory components in each country Implemented standardized questionnaire at EID sites to understand sample volume and programmatic practices, and key informant interviews with national program partners to learn about program scale up and program management

  4. EID sample volumes have increased steadily in all four countries Background on the national EID service scale up (sample volumes) Background on National EID Programs Quarterly EID Sample Volume since Start of Program (HV) Namibia Uganda Senegal* Cambodia Samples per quarter Quarterly volumes are steadily rising in Uganda, Senegal and Cambodia, all three still <50% EID Coverage (in 2008) Quarterly EID Sample Volume since Start of Program (LV) Samples per quarter (*) Quarterly data not available, yearly volumes averaged

  5. Less than one half of infants ever tested via EID across these four countries were tested in their first two months of life. Coverage of the optimal service (early testing) is consequently even lower Portion of HIV Exposed Infants in Need Receiving EID Service in First Two Months of Life Missed early testing opportunities: PMTCT follow up appointments, vaccination schedule

  6. Of those infants testing HIV positive via EID, attrition post testing is significant Follow up of Infants Testing Positive via EID at Review Sites Uganda-72% not alive & on ART Cambodia- 67% not alive & on ART 100 3182 93 90 2330 Infants Infants 87 38 1170 33 878 No data Positive via EID Rec. Results Enrolled Initiated on ART Active on ART Positive via EID Results at Site Received Results/ Enrolled Initiated on ART Active on ART 2330 Senegal 67% not alive & on ART 27 14 Infants No data 6 4 Patients EID tested Patients lost Positive via EID Enrolled Received Results Initiated Alive on ART

  7. Lessons learned provide strategic opportunities to bolster EID Understanding the operational challenges hindering the implementation and impact of EID can help to target future investments • The landscape for HIV exposed infants and young children is better today than it has ever been before: • PMTCT coverage is increasing. • Infant testing services are becoming widely available. • Children respond exceedingly well to ART if tested early and treated early. • There is significant Ministry and partner momentum and investment • There are clearly numerous challenges related to the implementation of EID which merit particular attention as they are dramatically curtailing the impact of the service such as late age at testing, centralized service uptake, and still slowly rising service coverage • With these findings, Ministries of Health have already begun to strategize, pilot and address critical bottlenecks in order to optimize the impact of the EID service

  8. Deepest thanks to all four Ministries of Health who led these EID service reviews: Dr. Mean Chhi Vun and Dr. Sok Panha, Ministry of Health, Kingdom of Cambodia  Ministry of Health and Social Services, Republic of Namibia  Dr. Charles Kiyaga, Ministry of Health Republic of Uganda  Dr. Abdoulaye S. Wade, Ministère de la Santé, Republique du Sénégal  UNICEF HQ and UNICEF country offices, particularly R. Gass

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