Point-of-Care Diagnostics
Half of the infants infected with HIV through mother-to-child transmission, who remain untreated, will die before their second birthday. Their mortality risk spikes at just six to eight weeks of age, making it critical that we increase early testing and diagnosis of infants in order to initiate lifesaving treatment.
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) worked in nine countries to integrate point-of-care (POC) technology to rapidly test HIV-exposed infants and link those who test positive to early treatment. The technology has enabled testing of over 130,000 HIV-exposed infants, most commonly returning results to caregivers on the same day, and has linked nearly 5,000 HIV-positive infants to swift, lifesaving treatment.
POC early infant diagnosis (EID) has meant that 93% of HIV-infected infants start lifesaving HIV therapy within 60 days of testing positive, as opposed to just 43% using centralized laboratory-based testing methods. These platforms are now being further programmed to provide viral load assessments of clients on antiretroviral therapy (ART), and in some settings, they are also being used for TB and human papillomavirus (HPV) diagnosis.
The POC-EID Project
We approached this project in phases at both the global and the country level, carrying out policy assessments and engaging in global advocacy to ensure investment in this technology. Working hand-in-hand with ministries of health, EGPAF assessed existing health infrastructure, examined historical EID test volumes, placed POC platforms in sites with a higher volume of infants being tested for HIV (as stand-alone or hub testing centers), and secured transport and SMS messaging for “spoke” sites with lower volumes, which would send samples to nearby hubs (alleviating the burden on central laboratories).
The use of hub-and-spoke testing increased access to POC EID by more than sixfold while containing costs and ensuring operator proficiency. Notably, the difference in key service delivery indicators between the testing and spoke sites was minimal, making the hub-and-spoke model a viable option to optimize POC EID. The project team worked with local partners to develop and implement transition plans, ensuring the sustainability of this work.
A pilot phase informed greater scale-up and the project resulted in POC testing access among 1,600 sites across nine countries. Critical data was generated on feasibility, acceptability, impact, and cost-effectiveness was then collected, analyzed, and updated in near real-time throughout the project, made available on a live data dashboard.
The Outcomes:
