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Towards getting more HIVpositive infants on lifesaving treatment: assessing turnaround times for early infant diagnosis in Lesotho M Gill, HJ Hoffman, A Isavwa, M Mokone, M Foso, JT Safrit, A Tiam MOAD0202 1 Kingdom of Lesotho Population 1.9 million HIV prevalence among pregnant women 27.7% ANC attendance (first visit) 91.8% Deliveries in health facilities 69.8% HIV testing in ANC 95% Maternal PMTCT coverage (facility based) 96% Infant prophylaxis uptake (facility based) 97% DHS-MOH , 2009; Annual joint review MOH, 2013. Background Globally, only 34% of ART eligible children aged <15 years are receiving ART Without treatment, 1/3 of HIV-infected children will not see their first birthday and almost 1/2 will die before 2 years of age In Lesotho 37,000 children are living with HIV 38% of eligible children are receiving ART Average ART initiation is 5 years of age Long turn-around-time (TAT) for early infant diagnosis (EID) has been identified as a significant challenge DK. Ekouevi et all 2011 ; WHO/UAIDS/UNICEF Universal Access 2011; S. Essajee, 2010; UNAIDS, 2013 Objectives 1) To identify delays in the EID process, from sample collection to receipt of results by caregiver and infant ART initiation in HIV infected infants 2) To determine the 6-8 week HIV infection rate among HIV exposed infants who had an EID test done Methods Retrospective review of all 6-8 week-old, HIV-exposed infants who received an HIV test in selected sites in 2011; central lab records linked to facility records 25 purposefully selected study sites: Included sites from both hospitals and health centers and each of the three geographic zones Included 11 hard-to-reach sites with higher-thanaverage EID turnaround time TAT for EID was calculated using abstracted dates from laboratory EID database and registers Geometric means (with 95% CI) for TAT were calculated and compared by region using linear mixed models Step-by-step DNA-PCR testing in Lesotho Infant/mother characteristics HIV-exposed infants with 6-8 week EID (n=1187) Mean age at blood draw (days) 47 HIV-positive children (n) 47 HIV transmission rate at 6-8 weeks 4% HIV infected mothers of study infants (n=1045) Mean maternal age (years) Mean gravida/parity 28 2.4/1.4 Mean number of ANC visits 3.1 Mean gestational age at first ANC (weeks) 26 EID Total TAT time: 61.7 days (CI = 55.3, 68.7) 2.7 days Mean TAT per stage by Geography Specimen-district lab District lab -central lab Central lab -result to district lab District lab -result to health facility Health Facility -result to caregiver Result to caregiver- infant ART 0 Foothills 5 10 15 20 25 Number of Days Highlands 30 35 Lowlands 40 Mean TAT per stage by HIV status Specimen-district lab District lab -central lab Central lab -result to district lab District lab -result to health facility Health Facility -result to caregiver Result to caregiver- infant ART 0 HIV uninfected 5 10 15 Number of Days 20 HIV infected 25 Mean TAT from HIV positive results to initiation on ART distributed by region Time to ART 4.5 Number of days 4 3.5 3 2.5 Time to ART 2 1.5 1 0.5 0 Lowlands Foothills Highlands Mean Results return for HIV infected infants • HIV positive EID results are distributed by EGPAF through mobile 3-G internet to health facilities ahead of paper based results. • Once Health care workers are informed, community workers track the infant before the appointment date. Conclusions • Average TAT from specimen collection to caregiver receipt of test results in the study facilities was approximately 2 months. • The longest delay occurred between specimen receipt in the central laboratory and result receipt at the district laboratory • HIV infected infants had rapid ART initiation due to a system of expedited notification of positive results to caregivers and same-day treatment initiation • Interventions to expedite result transfer back to facilities and in-country testing would allow for faster initiation of infants on life-saving treatment ACKNOWLEDGEMENTS • Funding for this research was provided by the University of California Los Angeles (UCLA) student dance marathon program. • We would like to acknowledge: – The MOH of Lesotho – Health care workers in the sites – The research team and all EGPAF staff – Our patients Thank you!