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IAS Conference, 17 to 20 July 2011, Rome Hellen Muttai CDC Kenya

Utility of Early Infant Diagnostic (EID)Testing in Assessing the Impact of PMTCT Program Kenyan Experience. IAS Conference, 17 to 20 July 2011, Rome Hellen Muttai CDC Kenya. Kenya Background. Total population 38.6 million HIV prevalence 6% (KDHS 08)

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IAS Conference, 17 to 20 July 2011, Rome Hellen Muttai CDC Kenya

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  1. Utility of Early Infant Diagnostic (EID)Testing in Assessing the Impact of PMTCT ProgramKenyan Experience IAS Conference, 17 to 20 July 2011, Rome Hellen Muttai CDC Kenya

  2. Kenya Background • Total population 38.6 million • HIV prevalence 6% (KDHS 08) • Number of people living with HIV 1.4 million • Estimated annual pregnancies 1.5 million • ~ 96,000 among HIV positive women

  3. PMTCT Program, 2005-2010

  4. EID Program Scale Up in Kenya, 2005-2010 • Standardized • EID testing algorithm • Lab request form • Dried blood spot (DBS) samples collected • Shipped to labs by courier services • EID PCR testing initiated in 2003 • Currently in 6 labs

  5. Objectives • Assess utility of EID testing in assessing the impact of PMTCT program Study Setting • Retrospective review of Nyanza province EID data • Region has the highest HIV prevalence - 14% • Estimated 250,000 annual pregnancies • ~40,000 among HIV + women • First lab to do EID testing • Currently supporting a third of the national tests • Data readily available

  6. Methods • Study population • HIV exposed children <18 months receiving EID testing from 2008-2010 at 471 facilities • Data collection • Scannable lab form completed by clinician • DBS sample collected and sent to KEMRI/CDC lab • Data management • Sample tested and lab results placed on form • Results returned to clinical sites • Form scanned and stored in database • Patient IDs stripped from database; new study ID assigned • Descriptive analyses of demographic and clinical variables • Cochran Armitage trend test and Chi square tests were used to assess trends and differences between groups *KDHS 2010

  7. Demographic and Clinical Characteristics of HIV-exposed Children, 2008-2010 (n=28,598) *Cases with missing age omitted

  8. Proportion of HIV Positive Infants by Age and Patient Source *Cases with missing age omitted

  9. Proportion HIV Positive Children by Year & PMTCT History (N=28,598) *Cases with missing year omitted

  10. Comparing Proportion of HIV Positive Infants Using EID Data and PMTCT Impact Study in Kenya (MCH, Age 6-16 weeks, 2010)

  11. Between 2008 and 2010, 28,598 children received EID testing 13% were HIV positive HIV positivity higher with older age, tested through PITC, and those without documentation on mothers’ ARV use Results were comparable to the national survey Limitations: EID data use does not capture those not tested, about 40-50% in Kenya HIV status outcomes vary by age and patient source, and therefore can bias the results Lack or format of documentation on the lab request form was a challenge Conclusions

  12. Acknowledgement MOH Kenya PEPAR Team Kenya CDC Kenya • Lucy Wanjiku • Clement Zeh CDC Atlanta • Marta Ackers KEMRI/CDC • Jane Mutegi

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