Evaluating the early infant diagnosis point of care program in Uganda

Abstract

Background: At-birth and point-of-care (POC) early infant diagnosis (EID) testing are emerging strategies to streamline infant human immunodeficiency virus (HIV) diagnosis and expedite antiretroviral therapy initiation for HIV-positive infants. Uganda rolled out EID point of care testing in 2018 using Mpima/AlereQ and GeneXpert in 115 sites to ensure services are brought closer to the communities and enable early identification of HIV-infected infants leading to timely initiation to treatment and care

Objective: The purpose of this study was to evaluate the early infant diagnosis point of care program against the set targets to provide programmatic information and evidence of the effect of EID POC implementation.

Methods: This cross-sectional study followed an explanatory sequential design characterized by an initial quantitative analysis to identify best and worst performing health regions followed by a qualitative data collection to explain the enablers and barriers for EID POC performance.

Results: A sub-optimal timely EID uptake was realized with 76% of the HEIs against the target of 90% timely receipt of 1st PCR. Nearly three-quarter of the 1st PCR samples (73%, n=6001) were tested on the Mpima/AlereQ devices, and half of the samples tested at the general hospitals (50%, n=4151). Just over half (55%, n=4580) of infants tested were males and 71% of the infants accessed their test results within the same day of sample collection. The main entry point into care was the mother-baby (MBCP, 69% n=5709), followed by young child clinic (YCC, 23% n=5709). Linkage of the positive infants to care and treatment remained sub-optimal with 10% not linked within 1 week after receipt of results. Conclusion: The program ought to develop strategies to address health system gaps in service accessibility and quality, staffing required for service delivery, stock needed to conduct testing and community-level factors that include addressing stigma and patient literacy.