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Early infant diagnosis of HIV infection in low-income and middle-income countries: does one size fit all?

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JournalLancet Infectious Diseases
DateE-pub ahead of print - 21 Jan 2014
DatePublished (current) - Jul 2014
Issue number7
Volume14
Number of pages6
Pages (from-to)650-655
Early online date21/01/14
Original languageEnglish

Abstract

Despite expansion of services for prevention of mother-to-child transmission of HIV (PMTCT), about 700 infants acquire HIV every day. Early initiation of antiretroviral therapy for HIV-infected infants reduces mortality but requires diagnosis by virological testing, which is complex, expensive, and inaccessible in many settings. Little cost-effectiveness evidence exists about different strategies to deliver early infant diagnosis services. Cost-effectiveness will vary depending on entry points for testing, underlying prevalences of HIV, PMTCT coverage, treatment availability, programme attrition, and other factors. Appropriate policy responses are therefore context-specific. In most cases, early infant diagnosis should be concentrated at entry points where underlying infant HIV prevalence is highest (eg, malnutrition wards). This strategy contrasts with the tendency at present to test mainly within PMTCT programmes. If testing is undertaken in PMTCT programmes with high coverage, addition of a virological test at birth might have advantages, including greater predictive value, earlier diagnosis, and better infant follow-up. National programme managers should recognise the opportunity costs of the limited resources available, acknowledge the changing scenario of PMTCT scale-up, ensure implementation of provider-initiated testing and counselling, and tailor early infant diagnosis programmes to maximise health gains for children.

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© 2014 Elsevier Ltd. All rights reserved.

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