Compared with conventional testing programs, point-of-care (POC) testing for early HIV diagnosis in 8 sub-Saharan African countries substantially reduced the turnaround time for HIV test results and enabled earlier antiretroviral therapy (ART) initiation in infants, according to study results published in The Lancet HIV.
Conventional HIV testing in infants has many challenges, including lengthy delays between collection of blood samples and the availability of results, getting results to clinicians and caregivers, and initiating ART in infants infected with HIV. Since POC testing has the potential to speed up initiation of ART, researchers compared key service delivery and clinical outcomes and the cost of POC with conventional testing.
Using a hub-and-spoke model, a wide range of sites were selected including regional hospitals, primary healthcare facilities, prevention of mother-to-child transmission services, and maternity services. Researchers analyzed data from 2875 infants exposed to HIV who underwent conventional testing at 96 healthcare facilities and 18,220 infants exposed to HIV who underwent POC testing at 339 healthcare facilities.
There were significant improvements in outcomes with POC testing compared with conventional testing including:
- Higher number of valid results returned to caregivers within 30 days (98.3% vs 18.7%; P <.0001).
- Reduced median time from sample collection to return of results to caregivers (0 vs 55 days; P <.0001).
- Increased number of infants with HIV initiated ART within 60 days of sample collection (92.3% [639 of 692 infants] vs 43.3% [42 of 97 infants]; P <.0001).
- Decreased median time from sample collection to start of ART initiation in infants with HIV (0 vs 49 days; P <.0001).
- Lower median age at ART initiation in infants with HIV who were tested at 6 to 8 weeks (1.6 vs 3.3 months; P <.0001).
Moreover, the cost per test result returned within 30 days was less for POC testing compared with conventional testing (US $27.24 vs $131.02).
Given that POC testing represents a high-impact, high-value, intervention, it can easily be used to achieve the first 2 goals of the 90-90-90 targets for HIV: ensuring that 90% of people living with HIV know their status and 90% of people who know their status begin to receive ART. “National programs, funders, and implementing partners should consider POC [early infant HIV diagnosis] as a preferred testing strategy for implementation,” concluded the researchers.
Bianchi F, Cohn J, Sacks E, Bailey R, Lemaire JF, Machekano R; EGPAF POC EID Study Team. Evaluation of a routine point-of-care intervention for early infant diagnosis of HIV: an observational study in eight African countries. Lancet HIV. 2019;6(6):e373-e381.