Shortening Turnaround Times for Newborn HIV Testing in Rural Tanzania: A Report from the Field

Newborns infected with HIV before, during, or shortly after delivery have high mortality, with 50% dying before one year of age, and 20% of these early deaths occurring between the first and third months of life [1]. Early diagnosis and treatment reduces mortality by up to 76% [2], but neonatal diagnosis is difficult. Antibody-based rapid HIV tests frequently yield false positive results because of transplacental transfer of maternal antibodies that can persist in the child’s circulation for up to 18 months [3]. For this reason, polymerase chain reaction (PCR)-based viral nucleic acid tests are recommended instead [4]. At present, viral DNA or RNA can only be identified in a laboratory with the technical capacity to perform PCR.

The demonstration that HIV RNA and DNA can be detected in dried blood spots (DBS) revolutionized newborn HIV testing in resource-poor areas in which laboratory facilities are limited [5]. Unlike serum samples that must either be tested within hours of collection or frozen for transport, DBS can be stored in warm, humid climates and later transported to reference laboratories for testing while still yielding accurate results [6]. These findings led the World Health Organization to endorse DBS testing as the single screening tool for all infants born to mothers with HIV infection or unknown HIV status [4]. Given that DBS are additionally now being used for viral load monitoring, drug resistance genotyping, and even neonatal screening for hereditary diseases [7–9], ensuring the feasibility and reliability of this system is crucial.

In northwestern Tanzania, where we work, Bugando Medical Center (BMC) serves as the reference laboratory for early infant diagnosis (EID) of HIV-exposed children. The laboratory’s EID program was first piloted in 2006 [10]. BMC’s laboratory serves a population of 13 million people, receiving DBS from 96 clinics in the seven regions surrounding the medical center…

Below:  Flow diagram of steps required for rural dried blood spot HIV viral load testing and median times to completion at baseline

Below:  Turnaround times from dried blood spot collection until result available at health center (blue dashed line) or result given to mother (red solid line)

Full article at: http://goo.gl/GZpwJl

By:

Sabina Manumbu, Anna Mwale

Bugando Medical Centre Care and Treatment Center/Baylor College of Medicine Children’s Foundation Tanzania, Mwanza, Tanzania

Luke R. Smart, Jennifer A. Downs

Department of Internal Medicine, Catholic University of Health & Allied Sciences–Bugando, Mwanza, Tanzania

Luke R. Smart, Jennifer A. Downs

Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America

Kedar S. Mate

Department of Internal Medicine, Weill Cornell Medical College, New York, New York, United States of America

Kedar S. Mate

Institute for Healthcare Improvement, Cambridge, Massachusetts, United States of America

  

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