ias conference, 17 to 20 july 2011, rome hellen muttai cdc kenya
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Utility of Early Infant Diagnostic (EID)Testing in Assessing the Impact of PMTCT Program Kenyan Experience. IAS Conference, 17 to 20 July 2011, Rome Hellen Muttai CDC Kenya. Kenya Background. Total population 38.6 million HIV prevalence 6% (KDHS 08) - PowerPoint PPT PresentationTRANSCRIPT
Utility of Early Infant Diagnostic (EID)Testing in
Assessing the Impact of PMTCT Program
Kenyan ExperienceIAS Conference, 17 to 20 July 2011,
RomeHellen Muttai
CDC Kenya
Kenya Background
Total population 38.6 million
HIV prevalence 6% (KDHS 08)
Number of people living with HIV 1.4 million
Estimated annual pregnancies 1.5 million
~ 96,000 among HIV positive women
PMTCT Program, 2005-2010
2005 2006 2007 2008 2009 2010 -
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000 3
18,3
61
575,3
54
785,8
40
988,7
98
1,0
57,2
41
1,1
77,3
85
19,4
39
34,7
95
50,6
59
61,1
25
59,5
91
70,7
32
926 1,443
2,092
3,661
3,700
4,000 Mothers Tested Mothers given ARVs No. PMTCT Sites
No
. o
f P
MT
CT
Sit
es
Wo
me
n T
este
d/o
n A
RV
s
EID Program Scale Up in Kenya, 2005-2010
Standardized • EID testing
algorithm • Lab request
form
Dried blood spot (DBS) samples collected
Shipped to labs by courier services
EID PCR testing initiated in 2003
Currently in 6 labs
2005200620072008200920100
10000
20000
30000
40000
50000
60000
0
200
400
600
800
1000
1200
1400
1600
1800
Number of EID tests doneNo of sites accessing EID
Num
ber
of E
ID te
sts
done
Num
ber
of
faci
litie
s acc
ess
-in
g E
ID
Objectives
Assess utility of EID testing in assessing the impact of PMTCT program
Study Setting
Retrospective review of Nyanza province EID data • Region has the highest
HIV prevalence - 14%• Estimated 250,000
annual pregnancies• ~40,000 among HIV +
women• First lab to do EID testing• Currently supporting a
third of the national tests• Data readily available
Methods
Study population• HIV exposed children <18 months receiving EID testing
from 2008-2010 at 471 facilities Data collection
• Scannable lab form completed by clinician• DBS sample collected and sent to KEMRI/CDC lab
Data management• Sample tested and lab results placed on form• Results returned to clinical sites• Form scanned and stored in database• Patient IDs stripped from database; new study ID
assigned Descriptive analyses of demographic and clinical variables
• Cochran Armitage trend test and Chi square tests were used to assess trends and differences between groups
*KDHS 2010
Demographic and Clinical Characteristics of HIV-exposed Children, 2008-2010 (n=28,598)
N (%)
Age
0-3 months 17,023 (63)*
4-9 months 7,250 (27)*
10-18 months 2,614 (10)*
Gender Female 13, 703 (48)
Patient source
Maternal Child Health (MCH) 13,704 (48)
HIV Clinic 9,979 (35)
Provider Initiated Testing and Counseling (PITC)
1,265 (4)
Other/not documented 3,650 (13)
Maternal ARV historyARVs for PMTCT 10,777 (38)
Not documented 17,821 (62)
Infant breastfeeding status
Breastfeeding 19,155 (67)
Not documented 9,443 (33)*Cases with missing age omitted
Number of HIV Positive Children
Patient SourceAll
N=28,598 (%)
0-3 months
N=17,023* (%)
4-9 months
N=2,158* (%)
10-18 months N=456*
(%)
All 3,759 (13) 1,731 (10) 1,199 (17) 682 (27)
Patient source
MCH (n=13,704) 1,599 (12) 870 (10) 499 (15) 178 (24)
HIV Clinic (n=9,979) 1,422 (14) 575 (10) 457 (16) 353 (31)
Provider Initiated Testing and Counseling (n=1,265)
311 (25) 101 (20) 117 (27) 84 (29)
Other/Not documented (n=3,650)
427 (12) 185 (9) 126 (20) 67 (21)
Proportion of HIV Positive Infants by Age and Patient Source
*Cases with missing age omitted
Proportion HIV Positive Children by Year & PMTCT History (N=28,598)
N Number of children HIV positive (%) p value
Year
2008 2,380* 358 (15)
0.0092009 11,099* 1,520 (14)
2010 14,093* 1,843 (13)
Maternal ARV history
ARVs for PMTCT 10,777 (38) 942 (9)<0.001
Not documented 17,821 (62) 2,817 (16)
Breastfeeding status
Yes 19,155 (67) 2,513 (13)0.87
Not documented 9,443 (33) 1,246 (13)
*Cases with missing year omitted
Comparing Proportion of HIV Positive Infants Using EID Data and PMTCT Impact Study in
Kenya (MCH, Age 6-16 weeks, 2010)EID data for MCH , age
6-16 weeks (n=3,795)
PMTCT Impact Study (4,248)
Overall Positivity Rate 9% 10%
Mother’s ARV use
Yes 6% 9%
No or not sure _ 10%
Not documented 11% _
Infant breast feeding status
Yes 9% _
Not documented 7% _
Not breastfeeding _ 8%
Exclusive breastfeeding _ 8
Mixed feeding _ 15%
Conclusions
Between 2008 and 2010, 28,598 children received EID testing 13% were HIV positive HIV positivity higher with older age, tested through
PITC, and those without documentation on mothers’ ARV use
Results were comparable to the national survey Limitations:
• EID data use does not capture those not tested, about 40-50% in Kenya
• HIV status outcomes vary by age and patient source, and therefore can bias the results
• Lack or format of documentation on the lab request form was a challenge
For more information please contact CDC-Kenya
E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Acknowledgement
MOH KenyaPEPAR Team Kenya CDC Kenya
•Lucy Wanjiku•Clement Zeh
CDC Atlanta•Marta Ackers
KEMRI/CDC• Jane Mutegi