title: If you text them, they will come: using the HIV infant tracking system to improve early infant diagnosis quality and retention in Kenya.
abstract: OBJECTIVE
  The objective of this study is to evaluate the impact of the HIV Infant Tracking System (HITSystem) for quality improvement of early infant diagnosis (EID) of HIV services.
  
  
  METHODS
  This observational pilot study compared 12 months of historical preintervention EID outcomes at one urban and one peri-urban government hospital in Kenya to 12 months of intervention data to assess retention and time throughout the EID cascade of care.
  
  
  METHODS
  Mother-infant pairs enrolled in EID at participating hospitals before (n = 320) and during (n = 523) the HITSystem pilot were eligible to participate.
  
  
  METHODS
  The HITSystem utilizes Internet-based coordination of the multistep PCR cycle, automated alerts to trigger prompt action from providers and laboratory technicians, and text messaging to notify mothers when results are ready or additional action is needed.
  
  
  METHODS
  The main outcome measures were retention throughout EID services, meeting time-sensitive targets and improving results turn-around time, and increasing early antiretroviral therapy (ART) initiation among HIV-infected infants.
  
  
  RESULTS
  The HITSystem was associated with an increase in the proportion of HIV-exposed infants retained in EID care at 9 months postnatal (45.1-93.0% urban; 43.2-94.1% peri-urban), a decrease in turn-around times between sample collection, PCR results and notification of mothers in both settings, and a significant increase in the proportion of HIV-infected infants started on antiretroviral therapy at each hospital(14 vs. 100% urban; 64 vs. 100% peri-urban).
  
  
  CONCLUSIONS
  The HITSystem maximizes the use of easily accessible technology to improve the quality and efficiency of EID services in resource-limited settings.
authors.affiliation: aUniversity of Kansas Medical Center, Department of Family Medicine, Kansas City, Kansas bGlobal Health Innovations, Kansas City, Missouri, USA cKenya Medical Research Institute, Nairobi, Kenya dHealth Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri eTexas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital fDepartment of Pathology & Immunology, Baylor College of Medicine gHealth Empowering Humanity, Houston, Texas, USA hKenya Ministries of Health, National AIDS and STI Control Programme, Nairobi, Kenya iUniversity of Kansas, Department of Global Studies, Lawrence, Kansas jDepartment of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Finocchario-Kessler
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Gautney
authors.forename: Samoel
authors.initials: S
authors.lastname: Khamadi
authors.forename: Vincent
authors.initials: V
authors.lastname: Okoth
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Spinler
authors.forename: Anne
authors.initials: A
authors.lastname: Mwangi
authors.forename: Davies
authors.initials: D
authors.lastname: Kimanga
authors.forename: Kristine F
authors.initials: KF
authors.lastname: Clark
authors.forename: Helen D
authors.initials: HD
authors.lastname: Olungae
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Preidis
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D010865:Pilot Projects; D017010:Reminder Systems; D060145:Text Messaging / Q000706:statistics & numerical data*