title: Feasibility of early infant diagnosis of HIV in resource-limited settings: the ANRS 12140-PEDIACAM study in Cameroon.
abstract: BACKGROUND
  Early infant diagnosis (EID) of HIV is a key-point for the implementation of early HAART, associated with lower mortality in HIV-infected infants. We evaluated the EID process of HIV according to national recommendations, in urban areas of Cameroon.
  
  
  RESULTS
  The ANRS12140-PEDIACAM study is a multisite cohort in which infants born to HIV-infected mothers were included before the 8(th) day of life and followed. Collection of samples for HIV DNA/RNA-PCR was planned at 6 weeks together with routine vaccination. The HIV test result was expected to be available at 10 weeks. A positive or indeterminate test result was confirmed by a second test on a different sample. Systematic HAART was offered to HIV-infected infants identified. The EID process was considered complete if infants were tested and HIV results provided to mothers/family before 7 months of age. During 2007-2009, 1587 mother-infant pairs were included in three referral hospitals; most infants (n = 1423, 89.7%) were tested for HIV, at a median age of 1.5 months (IQR, 1.4-1.6). Among them, 51 (3.6%) were HIV-infected. Overall, 1331 (83.9%) completed the process by returning for the result before 7 months (median age: 2.5 months (IQR, 2.4-3.0)). Incomplete process, that is test not performed, or result of test not provided or provided late to the family, was independently associated with late HIV diagnosis during pregnancy (adjusted odds ratio (aOR) = 1.8, 95%CI: 1.1 to 2.9, p = 0.01), absence of PMTCT prophylaxis (aOR = 2.4, 95%CI: 1.4 to 4.3, p = 0.002), and emergency caesarean section (aOR = 2.5, 95%CI: 1.5 to 4.3, p = 0.001).
  
  
  CONCLUSIONS
  In urban areas of Cameroon, HIV-infected women diagnosed sufficiently early during pregnancy opt to benefit from EID whatever their socio-economic, marital or disclosure status. Reduction of non optimal diagnosis process should focus on women with late HIV diagnosis during pregnancy especially if they did not receive any PMTCT, or if complications occurred at delivery.
authors.affiliation: Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. tejiokem@pasteur-yaounde.org
authors.forename: Mathurin C
authors.initials: MC
authors.lastname: Tejiokem
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
authors.forename: Ida C
authors.initials: IC
authors.lastname: Penda
authors.forename: Georgette
authors.initials: G
authors.lastname: Guemkam
authors.forename: Francis
authors.initials: F
authors.lastname: Ateba Ndongo
authors.forename: Gisèle
authors.initials: G
authors.lastname: Chewa
authors.forename: Claire
authors.initials: C
authors.lastname: Rekacewicz
authors.forename: Dominique
authors.initials: D
authors.lastname: Rousset
authors.forename: Anfumbom
authors.initials: A
authors.lastname: Kfutwah
authors.forename: Pascal
authors.initials: P
authors.lastname: Boisier
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
mesh_terms: D000328:Adult; D002163:Cameroon; D015331:Cohort Studies; D042241:Early Diagnosis; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006295:Health Resources; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis