Turnaround time for early infant HIV diagnosis in rural Zambia: a chart review.
BACKGROUND
Early infant HIV diagnosis is challenging in sub-Saharan Africa, particularly in rural areas where laboratory capacity is limited. Specimens must be transported to central laboratories for testing, leading to delays in diagnosis and initiation of antiretroviral therapy. This study was undertaken in rural Zambia to measure the turnaround time for confirmation of HIV infection and identify delays in diagnosis.


METHODS
Chart reviews were conducted from 2010-2012 for children undergoing early infant HIV diagnosis at Macha Hospital in Zambia. Relevant dates, receipt of drugs by mother and child for the prevention of mother-to-child transmission (PMTCT), and test results were abstracted.


RESULTS
403 infants provided 476 samples for early infant diagnosis. The median age at the "6-week" and "6-month" assessments was 8.1 weeks and 7.0 months, respectively. The majority of mothers (80%) and infants (67%) received PMTCT. The median time between sample collection and arrival at the central laboratory in Lusaka was 17 days (IQR: 10, 28); arrival at the central laboratory to testing was 6 days (IQR: 5, 11); testing to return of results to the clinic was 29 days (IQR: 17, 36); arrival of results at the clinic to return of results to the caregiver was 45 days (IQR: 24, 79). The total median time from sample collection to return of results to the caregiver was 92 days (IQR: 84, 145). The proportion of HIV PCR positive samples was 12%. The total median turnaround time was shorter for HIV PCR positive as compared to negative or invalid samples (85 vs. 92 days; p = 0.08).


CONCLUSIONS
Delays in processing and communicating test results were identified, particularly in returning results from the central laboratory to the clinic and from the clinic to the caregiver. A more efficient process is needed so that caregivers can be provided test results more rapidly, potentially resulting in earlier treatment initiation and better outcomes for HIV-infected infants.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
Catherine G
CG
Sutcliffe
Macha Research Trust, Macha Hospital, Choma, Zambia ; Department of Immunology and Infectious Diseases, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Janneke H
JH
van Dijk
Macha Research Trust, Macha Hospital, Choma, Zambia.
Francis
F
Hamangaba
Macha Research Trust, Macha Hospital, Choma, Zambia.
Felix
F
Mayani
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
William J
WJ
Moss
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D004279:DNA, Viral / Q000097:blood* / Q000235:genetics; D042241:Early Diagnosis; D005260:Female; D006678:HIV / Q000235:genetics*; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008297:Male; D016133:Polymerase Chain Reaction; D012424:Rural Population; D013997:Time Factors; D014186:Transportation; D015024:Zambia
D019380:Anti-HIV Agents; D004279:DNA, Viral