The primary goal of early infant diagnosis (EID) is to identify HIV+ infants prior to the development of clinical disease to facilitate early initiation o ART and improve infant survival. Nearly 20% of Kenyan infants born to HIV+ mothers each year become infected (roughly 20,000). Without early diagnosis and ART over half of these HIV+ infants will die by the age of two years; however, early antiretroviral therapy (ART) initiation (before 12 weeks) can reduce the risk of mortality by 76%. In 2008 Kenyan National Policy was revised to include rapid initiation of pediatric ART to all infants confirmed HIV+ with PCR testing The current EID system, however, is hampered by significant structural barriers that contribute to late and sporadic testing of HIV exposed infants, lost or delayed test results from the laboratory, and the absence of a reliable system to notify mothers of test results or the need to return to the hospital. Consequently, only about one-third of HIV-exposed infants are retained in EID care until 18 months of age. The proposed study will evaluate the impact and cost-effectiveness of the HIV Infant Tracking System (HITSystem(c)), an online, intervention with automated alerts designed to overcome current EID barriers by prospectively tracking HIV-exposed infants, improving the communication of PCR results from laboratories to both clinics and mothers, and supporting existing networks to facilitate quality HIV pediatric care. This robust intervention allows clinicians, lab technicians, and program managers to track the time sensitive interventions of EID and ART programs in real-time through online entries which trigger action 'alerts' when time sensitive interventions are overdue for specific infants. A builtin text messaging system sends automated text messages to mothers' cell phones when test results are ready or follow up visits are needed. The ultimate goals of the HITSystem are to increase the number of HIV-exposed infants retained in EID services (until 18 months), and facilitate early ART initiation for infants diagnosed HIV+. Promising pilot data comparing pre (n=330) and post (n=460) HITSystem intervention data at two low resource hospitals in Kenya demonstrate acceptability and feasibility of implementing the system which led to highly significant improvements in EID retention (31% pre vs. 97% post), and ART initiation rates for infants diagnosed HIV+ (44% pre vs. 95% post).

Public Health Relevance

The public health impacts of the HITSystem(c) implementation in Kenya include: 1) improved EID quality and retention; 2) improved coverage of OI prophylaxis Cotrimoxazole to prevent pneumocystis carini pneumonia (PCP), the leading respiratory infection among HIV-exposed infants; 3) improved HIV+ infant survival by reducing the time from diagnosis to initiation of ART, thus reducing the risk of mortality; 4) improved infant bonding and care for infants who are confirmed HIV-negative through testing; and 5) improved communication and accountability between hospitals, laboratories and families resulting in quality EID care.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD076673-05
Application #
9268763
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Russo, Denise
Project Start
2013-07-15
Project End
2018-04-30
Budget Start
2017-05-01
Budget End
2018-04-30
Support Year
5
Fiscal Year
2017
Total Cost
$759,719
Indirect Cost
$182,035
Name
University of Kansas
Department
Family Medicine
Type
Schools of Medicine
DUNS #
016060860
City
Kansas City
State
KS
Country
United States
Zip Code
66160
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Finocchario-Kessler, Sarah; Gautney, Brad; Cheng, AnLin et al. (2018) Evaluation of the HIV Infant Tracking System (HITSystem) to optimise quality and efficiency of early infant diagnosis: a cluster-randomised trial in Kenya. Lancet HIV 5:e696-e705
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