Session 4 - Infant Follow-up and Early-Infant Diagnosis

Overview and ICAP Approach: Ruby Fayorsey, MD, MPH, Pediatric Clinical Advisor, described and outlined the model of care for exposed infant follow-up and early infant diagnosis including the course of care for the exposed infant such as growth monitoring, cotrimoxazole prophylaxis, developmental assessment and immunizations.  Ruby described the importance of early infant diagnosis as part of the pediatric basic care package, reviewed the ICAP early infant diagnosis protocol and described the continued importance of WHO criteria for presumptive diagnosis of severe HIV infection for purposes of initiating ART.

Country Experiences and Challenges: Ethiopia: Implementing Early Infant Diagnosis: Mengistu Tafesse Tenagashaw, MD, Pediatric Clinical Advisor, described implementation phases of a national infant diagnosis program using HIV DNA PCR with DBS including: technology transfer, dry blood spot (DBS) validation, initiation of DBS at selected pilot sites, expansion to 6 regional laboratories, and national rollout.  Mengistu described lessons learned such as the need to make infant follow-up part of PMTCT programs; the need for comprehensive training (e.g. on lab result interpretation and infant feeding counseling); and the need for frequent, intensive, supportive supervision and site-level mentorship.

Country Experiences and Challenges: Tanzania: Early Infant HIV Diagnosis Program: Aziz Abdallah, MD, Senior Program Officer for ICAP Tanzania, described the policy, laboratory, clinical care, and logistical components of the 2006-07 creation of Tanzania’s first infant diagnosis program focused on using DNA PCR with DBS.  Aziz highlighted the importance of engaging national and facility authorities in each step of implementation, developing a strong lost to follow-up (LTFU) tracing system, and phased supportive supervision allowing close monitoring during start-up when it is most needed, with a quick shift to ownership of the program by the site.

Issues raised during Question & Answer session:

  • Transportation and packaging
    • ICAP-Nigeria wants to expand PMTCT services, especially to rural areas.  Transportation, packaging, and appropriate technology for DBS test samples present a major challenge. 
    • ICAP-Ethiopia uses mail delivery service which is cheap and available everywhere.
    • ICAP-Tanzania is negotiating reduced-cost shipping via DHL, and is training staff on how to transport samples.  Tanzania is divided into four zones, and in each zone there is a PCR machine at a zonal hospital; having PCR equipment in each zone helps so the distance to the facility is not so far.
  • Partner implementers for DBS PCR
    • Ethiopia has four US government partners, including some that do renovations for the sites and some that help with logistics of transporting and testing samples.
    • ICAP-Tanzania is working with CDC to develop training materials.  ICAP will train zonal staff so they in turn can train others in their zones.  Next, ICAP will train US government partners on how to implement the program.

Cross-Country Strategizing
This activity created discussion groups with members from each country in order to maximize and leverage ICAP’s collective exposed infant follow-up and early infant diagnosis experience.  Each group was assigned a list of challenges identified by a specific ICAP country program.  They discussed and proposed solutions and reported back to the large group, after which country teams convened for a workplanning session on exposed infant follow-up and early infant diagnosis, ideally incorporating aspects of the cross-country suggestions into their workplans.

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