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Challenges in Early Infant Diagnosis using DBS: Addressing Implementation Gaps

Denis Tindyebwa, Director at Elizabeth Glaser Pediatric AIDS Foundation, highlights the challenges in EID, emphasizing the importance of identifying and testing exposed infants promptly. The data shows significant gaps in testing rates, delayed testing ages, and shortcomings in linking mothers to tested infants. The presentation explores strategies beyond specimen collection, such as clear SOPs, staff training, quality assurance, and feedback mechanisms. Key issues like timely CTX initiation, enrollment in care, and ART initiation are also addressed, emphasizing the need for an integrated approach and effective program implementation aligned with desired outcomes. Embracing newer, simpler, and more cost-effective technologies is essential for improving EID services.

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Challenges in Early Infant Diagnosis using DBS: Addressing Implementation Gaps

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  1. Early Infant Diagnosis using DBS: highlighting challenges Denis Tindyebwa Director Pediatric Care and Treatment Elizabeth Glaser Pediatric AIDS Foundation

  2. EID Reaching children “missed” by PMTCT

  3. Identifying and testing exposed infant • Only 10-50% PMCTC sites offer EID services • Less than 50% exposed children tested • Less than 20% of PMTCT mothers linked to tested infants • Average age at 1st DBS is over 6 months – only 40% tested within 3 months • Very few exposed children identified in MCH, Ped wards, OPD • Going beyond specimen collection and checking basic clinical parameters – weight, etc

  4. Taking specimens - DBS • Who orders the test, now & later • Clear simple SOPs • No of staff able to take specimen; • Task shifting? • Quality of specimens; • Feedback to sites on quality of specimen

  5. Going beyond doing PCR testing • 10% exposed children started on CTX within 8 weeks • 35% infants receiving results never enrolled in care • 54% Infants enrolled in care not started on ART

  6. DBS PCR Cascade July 08 –April 2009

  7. Conclusion • Implementation of EID requires an integrated approach • Planning and program implementation should always keep focus on intended outcome • Newer technologies; simpler, cheaper better

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