title: Uptake of early infant diagnosis in Thailand's national program for preventing mother-to-child HIV transmission and linkage to care, 2008-2011.
abstract: BACKGROUND
  Early infant diagnosis (EID) has been a component of Thailand's prevention of mother-to-child HIV transmission (PMTCT) programme since 2007. This study assessed the uptake, EID coverage, proportion of HIV-exposed infants receiving a definitive HIV diagnosis, mother-to-child transmission (MTCT) rates and linkage to HIV care and treatment.
  
  
  METHODS
  Infant polymerase chain reaction (PCR) testing data from the National AIDS Program database were analyzed. EID coverage was calculated as the percentage of number of HIV-exposed infants receiving ≥ 1 HIV PCR test divided by the number of HIV-exposed infants estimated from HIV prevalence and live-birth registry data. Definitive HIV diagnosis was defined as having two concordant PCR results. MTCT rates were calculated based on infants tested with PCR and applied as a best-case scenario, and a sensitivity analysis was used to adjust these rates in average and worst scenarios. We defined linkage to HIV care as infants with at least one PCR-positive test who were registered with Thailand's National AIDS Program. Chi-squared tests for linear trend were used to analyze changes in programme coverage.
  
  
  RESULTS
  For 2008 to 2011, the average EID coverage rate increased from 54 to 76% (p < 0.001), with 65% coverage (13,761/21,099) overall. The number of hospitals submitting EID samples increased from 458 to 645, and the percentage of community hospitals submitting samples increased from 75 to 78% (p = 0.044). A definitive HIV diagnosis was made for 10,854 (79%) infants during this period. The adjusted MTCT rates had significantly decreasing trends in all scenarios. Overall, an estimated 53% (429/804) of HIV-infected infants were identified through the EID programme, and 80% (341/429) of infants testing positive were linked to care. The overall rate of antiretroviral treatment (ART) initiation within one year of age was 37% (157/429), with an increasing trend from 28 to 52% (p < 0.001).
  
  
  CONCLUSIONS
  EID coverage increased and MTCT rates decreased during 2008 to 2011; however, about half of HIV-infected infants still did not receive EID. Most HIV-infected infants were linked to care but less than half initiated ART within one year of age. Active follow-up of HIV-exposed infants to increase early detection of HIV infection and early initiation of ART should be more widely implemented.
authors.affiliation: Division of Global HIV/AIDS and TB, Asia Regional Program, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand; hqa5@cdc.gov.
authors.forename: Thananda
authors.initials: T
authors.lastname: Naiwatanakul
authors.affiliation: Bureau of Health Promotion, Department of Health, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Nipunporn
authors.initials: N
authors.lastname: Voramongkol
authors.affiliation: Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Niramon
authors.initials: N
authors.lastname: Punsuwan
authors.affiliation: Division of Global HIV/AIDS and TB, Asia Regional Program, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand.
authors.forename: Rangsima
authors.initials: R
authors.lastname: Lolekha
authors.affiliation: United Nations Children's Fund (UNICEF) Thailand, HIV/AIDS Section, Bangkok, Thailand.
authors.forename: Robert
authors.initials: R
authors.lastname: Gass
authors.affiliation: Clinical Research Center, Department of Medical Science, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Hansa
authors.initials: H
authors.lastname: Thaisri
authors.affiliation: Faculty of Medical Technology, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Pranee
authors.initials: P
authors.lastname: Leechanachai
authors.affiliation: Division of Global HIV/AIDS and TB, Asia Regional Program, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand.|Division of Global HIV/AIDS and TB, Asia Regional Program, U.S. Centers for Disease Control and Prevention Atlanta, GA, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Wolfe
authors.affiliation: Bureau of Health Promotion, Department of Health, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Sarawut
authors.initials: S
authors.lastname: Boonsuk
authors.affiliation: The Thailand National Health Security Office (NHSO), Nonthaburi, Thailand.
authors.forename: Sorakij
authors.initials: S
authors.lastname: Bhakeecheep
mesh_terms: D015331:Cohort Studies; D003266:Continuity of Patient Care; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D009313:National Health Programs; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013785:Thailand; D013997:Time Factors
keywords: EID; HIV; Thailand; antiretroviral therapy; linkage to care; national PMTCT programme evaluation; prevention of mother-to-child HIV transmission