Lessons learned from implementing the HIV infant tracking system (HITSystem): A web-based intervention to improve early infant diagnosis in Kenya.

OBJECTIVES: Guided by the RE-AIM model, we describe preliminary data and lessons learned from multiple serial implementations of an eHealth intervention to improve early infant diagnosis (EID) of HIV in Kenya. METHODS: We describe the reach, effectiveness, adoption, implementation and maintenance of the HITSystem, an eHealth intervention that links key stakeholders to improve retention and outcomes in EID. Our target community includes mother-infant pairs utilizing EID services and government health care providers and lab personnel. We also explore our own role as program and research personnel supporting the dissemination and scale up of the HITSystem in Kenya. RESULTS: Key findings illustrate the importance of continual adaptation of the HITSystem interface to accommodate varied stakeholders' workflows in different settings. Surprisingly, technology capacity and internet connectivity posed minimal short-term challenges. Early and sustained ownership of the HITSystem among stakeholders proved critical to reach, effectiveness and successful adoption, implementation and maintenance. CONCLUSIONS: Preliminary data support the ability of the HITSystem to improve EID outcomes in Kenya. Strong and sustained collaborations with stakeholders improve the quality and reach of eHealth public health interventions.

Analysis of the optimal cut-point for HIV-p24 antigen testing to diagnose HIV infection in HIV-exposed children from resource-constrained settings.

BACKGROUND: Nucleic-acid-testing (NAT) to diagnose HIV infection in children under age 18 months provides a barrier to HIV-testing in exposed children from resource-constrained settings. The ultrasensitive HIV-p24-antigen (Up24) assay is cheaper and easier to perform and is sensitive (84-98%) and specific (98-100%). The cut-point optical density (OD) selected for discriminating between positive and negative samples may need assessment due to regional differences in mother-to-child HIV-transmission rates. OBJECTIVES: We used receiver operator characteristics (ROC) curves and logistic regression analyses to assess the effect of various cut-points on the diagnostic performance of Up24 for HIV-infection status among HIV-exposed children. Positive and negative predictive values at different rates of disease prevalence were also estimated. STUDY DESIGN: A study of Up24 testing on dried blood spot (DBS) samples collected from 278 HIV-exposed Haitian children, 3-24-months of age, in whom HIV-infection status was determined by NAT on the same DBS card. RESULTS: The sensitivity and specificity of Up24 varied by the cut-point-OD value selected. At a cut-point-OD of 8-fold the standard deviation of the negative control (NCSD), sensitivity and specificity of Up24 were maximized [87.8% (95% CI, 83.9-91.6) and 92% (95% CI, 88.8-95.2), respectively]. In lower prevalence settings (5%), positive and negative predictive values of Up24 were maximal (75.9% and 98.8%, respectively) at a cut-point-OD that was 15-fold the NCSD. CONCLUSIONS: In low prevalence settings, a high degree of specificity can be achieved with Up24 testing of HIV-exposed children when a higher cut-point OD is used; a feature that may facilitate more frequent use of Up24 antigen testing for HIV-exposed children.

Reverse transcriptase inhibitors drug resistance mutations in drug-naive HIV type 1 positive Kenyans.

OBJECTIVE: To evaluate the extent of HIV-1 drug resistance among drug naive Kenyan individuals. DESIGN: Cross-sectional study. SETTING: Kenya Medical Research Institute HIV laboratory Nairobi, Kenya. SUBJECTS: A total of seventy eight HIV-1 positive drug naive subjects randomised from five Kenyan provincial hospitals between April and June 2004. RESULTS: A major non-nucleoside reverse transcriptase (NNRTI) an associated mutation was found in one patient (1.3%). NNRTI associated resistance mutations were present at amino acid codon sites G98A (2.56%); K103E (1.3%) and L100F (3.57%) prevalences. Baseline resistance may compromise the response to standard NNRTI-based first-line ART in 1.3 % of the study subjects. CONCLUSION: This indicates in general, that drug resistance among HIV-1 positive drug naive individual is at low thresholds (1.3%) but the problem could be more serious than reported here. Continuous resistance monitoring is therefore warranted to maintain individual and population-level ART effectiveness.