New in Early Infant Diagnosis

Early infant diagnosis establishes the presence of HIV infection in HIV-exposed infants and children younger than 18 months of age. An essential first step in caring for HIV-infected children is accurate and early diagnosis of HIV—early HIV testing, prompt return of results, and rapid initiation of treatment. Globally between 2002-2016 there was a 66% decline in new pediatric HIV infections; however, only ~50% of HIV-exposed infants received a test by two months of age in 2016 in 21 priority countries (UNAIDS, 2017). This collection of resources and tools helps you find what you need to scale up early infant diagnosis.

Global Guidance and Country Experiences

New! Catalysing Paediatric HIV Early Diagnosis and Treatment within West and Central Africa Country Catch-up Plans: Report of the Meeting at ICASA 2017 and Agenda for Action

UNICEF & UNAIDS, 2018.

In West and Central Africa, there has not been enough progress in increasing access to ART for children (aged 0–14 years)—and the treatment gap between ART for children and ART for adults is increasing. This report reviews a meeting convened by UNICEF and UNAIDS to reflect on the shortfalls within West and Central Africa country catch-up plans and to agree on ways to sharpen acceleration strategies and interventions that will increase access to pediatric ART. A key challenge identified is to address the lack of testing of infants known to be HIV-exposed and the testing of older children outside of PMTCT programs.

New! [Collection] Viral Load Monitoring Scale-Up Update in Uganda—Data Updates

PEPFAR Uganda & MOH Uganda Central Public Health Laboratories (CPHL), 2018.

This package of materials includes a summary of viral load monitoring approaches, outcomes, and next steps in Uganda as well as presentations from the March 2018 PEPFAR Uganda Integrated Viral Load/Early Infant Diagnosis & Tuberculosis Data Review Meeting.

  • Viral Load Monitoring: The Last Mile in Realising the Continuum of Response for HIV Care and Treatment
    Uganda M&E Technical Support Program, 2018.
    The Uganda M&E Technical Support Program (METS) with funding from PEPFAR has supported the Ministry of Health Central Public Health Laboratories to scale up viral load (VL) monitoring to over 80% of people living with HIV on antiretroviral therapy between 2016 and 2017 with the use of a VL dashboard, support for curriculum development, capacity building trainings, and continuous quality improvement initiatives. This article summarizes VL monitoring approaches, outcomes, and next steps in Uganda.
    View Online

  • Presentation: Integrated VL/EID & TB Data Review—March 2018
    PEPFAR Uganda & MOH Uganda Central Public Health Laboratories (CPHL), 2018.
    This presentation from the March 2018 PEPFAR Uganda Integrated Viral Load (VL)/Early Infant Diagnosis (EID) & Tuberculosis (TB) Data Review Meeting reviews progress in national VL monitoring, EID, and TB. It introduces key activities including the ‘HIV Situation Room’—an interactive software platform to centralize real-time service delivery data to improve tracking and programming.
    View Online

  • Presentation: PEPFAR PMTCT-EID FY18 Q1 Performance—Summary of Key EID Indicators
    PEPFAR Uganda, 2018.
    This presentation from the March 2018 PEPFAR Uganda Integrated Viral Load (VL)/Early Infant Diagnosis (EID) & Tuberculosis (TB) Data Review Meeting reviews implementing partner EID performance and approaches to scale-up and quality improvement.
    View Online

  • Presentation: Progress in Scale up of VL/EID & TB Monitoring for Moroto & Kotido
    USAID RHITES-E Project, 2018.
    This presentation from the March 2018 PEPFAR Uganda Integrated Viral Load (VL)/Early Infant Diagnosis (EID) & Tuberculosis (TB) Data Review Meeting reviews VL coverage trends and suppression rates, successful VL scale-up efforts, as well as challenges and recommendations in Moroto and Kotido districts. The presentation also covers EID and TB trends and challenges.
    View Online

Laboratory Management

New! Point-of-Care Versus Reference Laboratory Testing for Early Infant Diagnosis of HIV in Mozambique

ICAP, 2018.

This ICAP synopsis of a cluster-randomized controlled trial describes an evaluation of the effect of point-of-care (POC) early infant HIV testing on rates of antiretroviral therapy (ART) initiation and retention in care among HIV-positive infants who presented for early infant diagnosis at health facilities in Mozambique. Full synopsis is also available in French.

New! Significant Patient Impact Observed Upon Implementation of Point-of-Care Early Infant Diagnosis Technologies in an Observational Study in Malawi

Mwenda, R. et al. (2018). Clin Infect Dis. DOI: 10.1093/cid/ciy169.

In this observational study, point-of-care (POC) early infant diagnosis (EID) technologies were introduced into routine services at seven health facilities in Malawi. Antiretroviral therapy initiation rates were significantly improved with the implementation of same-day POC EID testing compared with referred, longer-turnaround laboratory-based testing.

New! Integrated Management of HIV, HCV, TB and Other Co-Infections

Unitaid & WHO, 2018.

This UNITAID landscape reviews multi-disease diagnostic platforms currently on the market or in the pipeline. Multi-disease diagnostic platforms hold the potential to streamline and simplify infectious disease diagnosis and management including HIV viral load testing and early infant diagnosis. They could reduce the cost of testing via an integrated network approach, improve the management of co-infections, and increase case-finding of individuals with specific co-infections.

New! Tools for HIV-Exposed Infant Care and Infant Virologic Testing

CDC, 2018.

This toolkit provides practical tools and training materials to guide health care workers in providing clinical care and testing to HIV-exposed infants (HEIs), including infant virologic testing.
View Online

  • Care of the HIV-Exposed Infant Flipchart
    CDC, 2018.
    This clinical job aid addresses the importance of maternal health and antiretroviral therapy adherence, as well as care and testing for the HIV-exposed infant until the infant’s final HIV diagnosis after the end of breastfeeding.
    View Online

  • Job Aid: Collection of Dried Blood Spots (DBS) from Infants for PCR Testing
    CDC, 2018.
    This clinical job aid provides health care workers with information on how to collect specimens for early infant diagnosis on dried blood spots, as well as drying and packaging for transport.
    View Online

  • Job Aid: Guide for Receiving and Storing Dried Blood Spots (DBS) for Molecular Testing at Reference Laboratories
    CDC, 2018.
    This job aid provides information for laboratorians about how to receive, process, and store dried blood spot specimens collected for early infant diagnosis, viral load, or drug resistance testing.
    View Online

Logistics

New! GLI Guide to TB Specimen Referral Systems and Integrated Networks

Global Laboratory Initiative (GLI)—Stop TB Partnership, 2018.

This guide, developed with USAID support, includes information relevant for tuberculosis (TB) program and laboratory managers, as well as Ministry of Health officials across disease programs interested in establishing integrated solutions for specimen referral. Though TB-focused in name, it offers integration-oriented assessment, design, and monitoring guidance related to improving coordination and efficiency, and is relevant for other programs as well. Country case studies include viral load and early infant diagnosis (EID) in Uganda and EID in Ethiopia.

Clinical Implementation

New! Video: Early Infant Diagnosis (EID) through Dried Blood Spot (DBS) Collection

CDC, 2018.

This CDC video—available in English, French, and Portuguese—reviews the skills needed to collect high quality dried blood spot (DBS) samples. It demonstrates how to: (1) Gather the supplies required for DBS collection; (2) Collect DBS samples on perforated cards; (3) Dry, package, and store (if necessary) DBS samples properly; (4) How to tell the difference between valid and invalid DBS; and (5) Ensure that all DBS cards are properly labeled and that specimen logs are kept accurately.

New! Tools for HIV-Exposed Infant Care and Infant Virologic Testing

CDC, 2018.

This toolkit provides practical tools and training materials to guide health care workers in providing clinical care and testing to HIV-exposed infants (HEIs), including infant virologic testing.
View Online

  • Care of the HIV-Exposed Infant Flipchart
    CDC, 2018.
    This clinical job aid addresses the importance of maternal health and antiretroviral therapy adherence, as well as care and testing for the HIV-exposed infant until the infant’s final HIV diagnosis after the end of breastfeeding.
    View Online

  • Job Aid: Collection of Dried Blood Spots (DBS) from Infants for PCR Testing
    CDC, 2018.
    This clinical job aid provides health care workers with information on how to collect specimens for early infant diagnosis on dried blood spots, as well as drying and packaging for transport.
    View Online

  • Job Aid: Guide for Receiving and Storing Dried Blood Spots (DBS) for Molecular Testing at Reference Laboratories
    CDC, 2018.
    This job aid provides information for laboratorians about how to receive, process, and store dried blood spot specimens collected for early infant diagnosis, viral load, or drug resistance testing.
    View Online

New! Where Have All the Children Gone? High HIV Prevalence in Infants Attending Nutrition and Inpatient Entry Points

Kiyaga C. (2018). JIAS 21:2. DOI: 10.1002/jia2.25089.

This study assessed HIV prevalence in infants and children receiving care at various service entry points in primary health facilities in Uganda. Expanding routine early infant diagnosis screening beyond the traditional PMTCT setting to nutrition and inpatient entry points can increase the identification of HIV‐infected infants and help HIV care programs significantly expand testing to improve access to EID and pediatric treatment.

Monitoring and Evaluation

New! [Collection] Viral Load Monitoring Scale-Up Update in Uganda—Data Updates

PEPFAR Uganda & MOH Uganda Central Public Health Laboratories (CPHL), 2018.

This package of materials includes a summary of viral load monitoring approaches, outcomes, and next steps in Uganda as well as presentations from the March 2018 PEPFAR Uganda Integrated Viral Load/Early Infant Diagnosis & Tuberculosis Data Review Meeting.

  • Viral Load Monitoring: The Last Mile in Realising the Continuum of Response for HIV Care and Treatment
    Uganda M&E Technical Support Program, 2018.
    The Uganda M&E Technical Support Program (METS) with funding from PEPFAR has supported the Ministry of Health Central Public Health Laboratories to scale up viral load (VL) monitoring to over 80% of people living with HIV on antiretroviral therapy between 2016 and 2017 with the use of a VL dashboard, support for curriculum development, capacity building trainings, and continuous quality improvement initiatives. This article summarizes VL monitoring approaches, outcomes, and next steps in Uganda.
    View Online

  • Presentation: Integrated VL/EID & TB Data Review—March 2018
    PEPFAR Uganda & MOH Uganda Central Public Health Laboratories (CPHL), 2018.
    This presentation from the March 2018 PEPFAR Uganda Integrated Viral Load (VL)/Early Infant Diagnosis (EID) & Tuberculosis (TB) Data Review Meeting reviews progress in national VL monitoring, EID, and TB. It introduces key activities including the ‘HIV Situation Room’—an interactive software platform to centralize real-time service delivery data to improve tracking and programming.
    View Online

  • Presentation: PEPFAR PMTCT-EID FY18 Q1 Performance—Summary of Key EID Indicators
    PEPFAR Uganda, 2018.
    This presentation from the March 2018 PEPFAR Uganda Integrated Viral Load (VL)/Early Infant Diagnosis (EID) & Tuberculosis (TB) Data Review Meeting reviews implementing partner EID performance and approaches to scale-up and quality improvement.
    View Online

  • Presentation: Progress in Scale up of VL/EID & TB Monitoring for Moroto & Kotido
    USAID RHITES-E Project, 2018.
    This presentation from the March 2018 PEPFAR Uganda Integrated Viral Load (VL)/Early Infant Diagnosis (EID) & Tuberculosis (TB) Data Review Meeting reviews VL coverage trends and suppression rates, successful VL scale-up efforts, as well as challenges and recommendations in Moroto and Kotido districts. The presentation also covers EID and TB trends and challenges.
    View Online

New! GLI Guide to TB Specimen Referral Systems and Integrated Networks

Global Laboratory Initiative (GLI)—Stop TB Partnership, 2018.

This guide, developed with USAID support, includes information relevant for tuberculosis (TB) program and laboratory managers, as well as Ministry of Health officials across disease programs interested in establishing integrated solutions for specimen referral. Though TB-focused in name, it offers integration-oriented assessment, design, and monitoring guidance related to improving coordination and efficiency, and is relevant for other programs as well. Country case studies include viral load and early infant diagnosis (EID) in Uganda and EID in Ethiopia.