Catalyzing Expanded Access to Early Testing, Care, and Treatment for HIV-exposed Infants in Kenya

Overview

Kenya is among four countries with the highest HIV disease burden in Africa (the others being Nigeria, South Africa, and Mozambique). As of 2015, approximately 1.5 million people, including an estimated 98,000 children under the age of 15 years, were living with HIV infection in Kenya, where HIV prevalence has remained stable at almost 6% over the last five years, with geographical variation ranging from 0.4% to 26% depending on the region. The mother-to-child HIV transmission rate stands at 6.1%.

Without treatment, up to 50% of HIV-infected children die before their second birthday, with a peak mortality at 2 to 3 months of age. Despite a relatively high pediatric treatment coverage rate – 77% of children living with HIV receiving antiretroviral therapy (ART) – the HIV-associated mortality rate among Kenyan children remains high at 14%.² Access to early infant HIV diagnosis (EID) screening is key to identifying HIV-positive infants as early as possible and immediately initiating them on lifesaving treatment. While currently up to 68% of HIV-exposed infants in Kenya have access to conventional laboratory-based EID, initiation of ART for HIV-infected infants is frequently delayed due to the long turnaround times (30-60 days currently in Kenya) from sample collection to return of results to providers and caregivers.³ The Elizabeth Glaser Pediatric AIDS Foundation in Kenya (EGPAF-Kenya), with funding from Unitaid, is integrating new-to-market, point-of-care (POC) technologies for EID into the existing national EID network. POC testing platforms are easy to use in a variety of health care entry points as they do not require trained laboratory technicians to operate. This POC technology, which does not require moving the sample to the central laboratory, allows HIV-exposed infants to be screened on-site at the facility and receive the test results the same day. Those infants with positive test results and newly identified HIV infection can be immediately started on ART. The project will adopt the hub-and-spoke model currently used by the conventional laboratory for sample transportation by placing POC platforms in hub sites which will support the testing of additional samples from nearby surrounding spoke sites (regularly sending samples to the hub sites for POC EID testing via the already-existing sample transportation network).