Enhancing Early Infant Diagnosis Timeliness at Migori District Hospital, Kenya

1. An evaluation of timeliness and turnaround time in early infant diagnosis at Migori District Hospital, Nyanza, Kenya Kadima, J.1,2, Gikonyo, L.1,2 Dillabaugh, L.2,3, Owuor,K.1,2, Cohen, CR.2,3, Bukusi, EA.1,2 Kevin Owuor Statistician UONCollaborative Meeting 24thJanuary 2013 1. Kenya Medical Research Institute (KEMRI), Nairobi, Kenya 2.     Family AIDS Care and Education Services, Kisumu, Kenya 3.     Departments of Pediatrics, Medicine, and Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, USA

2. Program Background • Family AIDS Care and Education Services (FACES) • Family-focused program • Collaboration between Kenya Medical Research Institute (KEMRI) and University of California, San Francisco (UCSF) • Operational since September 2004 in Nyanza and Nairobi • FACES program areas • Provider Initiated Testing and Counseling (PITC) • Prevention of Mother to Child Transmission (PMTCT) • HIV Care and Treatment • Voluntary Male Medical Circumcision (VMMC)

3. Background • An estimated 54,000 HIV-exposed infants are born annually in Nyanza Province • Timely early infant diagnosis (EID) is critical • Access to EID (Early Infant Diagnosis) is currently available within the region • However, delayed testing and prolonged turnaround time remain serious challenges

4. Infant brought for PCR test

5. Objective • To enhance EID and reduce turnaround time using a simple locally appropriate and sustainable intervention. • The intervention comprised of • Staff training on EID • Establishment & enforcement of maximum sample waiting times • Intensified mentorship of staff • Health talks for mothers • Introduction of PCR sample tracking log

6. Methods • Retrospective cohort study • Pre-post Intervention • Migori District Hospital • All HIV-exposed infants who underwent PCR testing during the following timeframes were compared: • Pre-intervention: Jul 1st 2010 to Dec 31st 2010 • Post-intervention: Jul 1st 2011 to Dec 31st 2011 • Sample size: 296 PCR tests • Pre-intervention: 155 • Post-intervention: 141

7. Methods: Data Collection • Data collected from infant charts, registers, and sample tracking logs • Analysis variables extracted: NB: All the ages and times are in days

8. PCR Flow • Timeliness was defined as 1st DNA PCR test done by 6 weeks of age for infants enrolled into care at the testing department (MCH and PSC). • Turnaround time at the Facility was calculated as the time difference between the date of PCR test and result received at the testing point (<=23 days [timely] or more than 23 days[untimely]). Infant enrollment (HEI) PCR test at main Facility Sample Dispatch to CDC lab Results to MDH main lab Results to main facility Parent Notification Sample Receipt at MDH main lab

9. Methods: Analysis • Bivariable analysis done using T test and wilcoxon ranksum test • Univariable and Multivariable Cox proportional hazards regression used to explore the association between Pre vs. Post Intervention period and time taken in entire PCR flow • The Survival model used was the Conditional Risk Set model

10. Results: Bivariable Analysis * Statistically significant (p<0.05)

11. Results: Survival Analysis * Statistically significant (p<0.05)

13. Conclusion • Results demonstrate that simple program interventions can result in earlier testing of HIV exposed infants and reduced turnaround time of PCR results.

14. Thank You