Top

Published in:

01-06-2020 | Human Immunodeficiency Virus

Predictors of Early ART Initiation Among HIV + Infants in Kenya: A Retrospective Review of HITSystem Data from 2013 to 2017

Authors: Catherine Wexler, Niaman Nazir, Brad Gautney, May Maloba, Melinda Brown, Kathy Goggin, Raphael Lwembe, Sarah Finocchario-Kessler

Published in: Maternal and Child Health Journal | Issue 6/2020

Abstract

Objective

Early initiation of antiretroviral therapy (ART, before 12 weeks of age) among infants living with HIV reduces infant mortality and slows disease progression. However, inefficiencies in early infant diagnosis processes prevents timely ART initiation among infants living with HIV in Kenya. This study assesses predictors of early ART initiation among infants living with HIV in Kenya.

Design

We retrospectively reviewed data from 96 infants living with HIV born between January 2013 and June 2017 at 6 Kenyan government hospitals.

Methods

The primary outcome was infant receipt of ART by 12 weeks of age. We assessed bivariable and multivariable predictors of ART initiation by 12 weeks of age.

Results

Among 96 infants living with HIV, 82 (85.4%) infants initiated ART at a median infant age of 17.1 weeks. Of the 82 infants who started ART, only 17 (20.7%) initiated ART by 12 weeks of age. In multivariable logistic regression analyses, testing per national guidelines (< 7 weeks of age) (aOR 40.14 [3.96–406.97], p = 0.002), shorter turnaround time for result notification (≤ 4 weeks) (aOR 11.30 [2.02–63.34], p = 0.006), and ART initiation within 3 days of mother notification (aOR 7.32 [1.41–38.03], p = 0.006) were significantly associated with ART initiation by 12 weeks of age.

Conclusion

Current implementation of early infant diagnosis services in Kenyan only achieves targets for early ART initiation in one-fifth of infants with HIV. Strengthening services to support earlier infant testing and streamlined processes for early infant diagnosis may increase the proportion of infants who receive timely ART.

Asbjornsdottir, K. H., Hughes, J. P., Wamalwa, D., Langat, A., Slyker, J. A., Okinyi, H. M., …, John-Stewart, G. (2016). Differences in virologic and immunologic response to antiretroviral therapy among HIV-1-infected infants and children. AIDS, 30(18), 2835–2843. https://doi.org/10.1097/qad.0000000000001244

Bourne, D. E., Thompson, M., Brody, L. L., Cotton, M., Draper, B., Laubscher, R., …, Myers, J. E. (2009). Emergence of a peak in early infant mortality due to HIV/AIDS in South Africa. AIDS, 23(1), 101–106

Cotton, M. F., Violari, A., Otwombe, K., Panchia, R., Dobbels, E., Rabie, H., …, Team, C. S. (2013). Early time-limited antiretroviral therapy versus deferred therapy in South African infants infected with HIV: Results from the children with HIV early antiretroviral (CHER) randomised trial. Lancet, 382(9904), 1555–1563. https://doi.org/10.1016/S0140-6736(13)61409-9

Finocchario-Kessler, S., Gautney, B., Cheng, A., Wexler, C., Maloba, M., Nazir, N., …, Goggin, K. (2018). Evaluation of the HIV Infant Tracking System (HITSystem) to optimise quality and efficiency of early infant diagnosis: A cluster-randomised trial in Kenya. The Lancet HIV, 5(12), e696–e705

Finocchario-Kessler, S., Gautney, B. J., Khamadi, S., Okoth, V., Goggin, K., Spinler, J. K., …, Preidis, G. A. (2014). If you text them, they will come: Using the HIV infant tracking system to improve early infant diagnosis quality and retention in Kenya. AIDS, 28 Suppl 3, S313–S321. https://doi.org/10.1097/qad.0000000000000332

Finocchario-Kessler, S., Goggin, K., Khamadi, S., Gautney, B., Dariotis, J. K., Bawcom, C., …, Okoth, V. (2015). Improving early infant HIV diagnosis in Kenya: Study protocol of a cluster-randomized efficacy trial of the HITSystem. Implementation Science, 10, 96. https://doi.org/10.1186/s13012-015-0284-3

Finocchario-Kessler, S., Odera, I., Okoth, V., Bawcom, C., Gautney, B., Khamadi, S., …, Goggin, K. (2015). Lessons learned from implementing the HIV infant tracking system (HITSystem): A Web-based intervention to improve early infant diagnosis in Kenya. Healthcare (Amst), 3(4), 190–195. https://doi.org/10.1016/j.hjdsi.2015.07.004

Gill, M. M., Hoffman, H. J., Mokone, M., Tukei, V. J., Nchephe, M., Phalatse, M., …, Mofenson, L. (2017). Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho. AIDS Research and Treatment, 2017, 2572594. https://doi.org/10.1155/2017/2572594

Goetghebuer, T., Haelterman, E., Le Chenadec, J., Dollfus, C., Gibb, D., Judd, A., …, European Infant Collaboration, g. (2009). Effect of early antiretroviral therapy on the risk of AIDS/death in HIV-infected infants. AIDS (London, England), 23(5), 597–604. https://doi.org/10.1097/QAD.0b013e328326ca37

Goggin, K., Hurley, E. A., Staggs, V. S., Wexler, C., Nazir, N., Gautney, B., …, Finocchario-Kessler, S. (2019). Rates and predictors of HIV-exposed infants lost to follow-up during early infant diagnosis services in Kenya. AIDS Patient Care STDS, 33(8), 346–353. https://doi.org/10.1089/apc.2019.0050

Goggin, K., Wexler, C., Nazir, N., Staggs, V. S., Gautney, B., Okoth, V., …, Finocchario-Kessler, S. (2016). Predictors of infant age at enrollment in early infant diagnosis services in Kenya. AIDS and Behavior, 20(9), 2141–2150. https://doi.org/10.1007/s10461-016-1404-z

Hassan, A. S., Sakwa, E. M., Nabwera, H. M., Taegtmeyer, M. M., Kimutai, R. M., Sanders, E. J., …, Berkley, J. A. (2012). Dynamics and constraints of early infant diagnosis of HIV infection in Rural Kenya. AIDS and Behavior, 16(1), 5–12. https://doi.org/10.1007/s10461-010-9877-7

Ibrahim, M., Moyo, S., Mohammed, T., Mupfumi, L., Gaseitsiwe, S., Maswabi, K., …, Shapiro, R. L. (2017). Brief report: High sensitivity and specificity of the cepheid xpert HIV-1 qualitative point-of-care test among newborns in Botswana. Journal of Acquired Immune Deficiency Syndromes, 75(5), e128-e131. https://doi.org/10.1097/qai.0000000000001384

Innes, S., Lazarus, E., Otwombe, K., Liberty, A., Germanus, R., Van Rensburg, A. J., …, Cotton, M. F. (2014). Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late? Journal of the International AIDS Society, 17(1), 18914. https://doi.org/10.7448/ias.17.1.18914

Jani, I., Meggi, B., Loquiha, O., Tobaiwa, O., Mudenyanga, C., Mutsaka, D., …, Peter, T. (2017). Effect of point-of-care testing on antiretroviral-therapy initiation rates in infants. In Paper presented at the Conference on Retroviruses and Opportunistic Infections, Seattle, Washington.

Jani, I. V., Meggi, B., Mabunda, N., Vubil, A., Sitoe, N. E., Tobaiwa, O., …, Peter, T. F. (2014). Accurate early infant HIV diagnosis in primary health clinics using a point-of-care nucleic acid test. Journal of Acquired Immune Deficiency Syndromes, 67(1), e1–e4. https://doi.org/10.1097/qai.0000000000000250

Marston, M., Becquet, R., Zaba, B., Moulton, L. H., Gray, G., Coovadia, H., …, Ghys, P. D. (2011). Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa. International Journal of Epidemiology, 40(2), 385–396. https://doi.org/10.1093/ije/dyq255

Ministry of Health. (2011). Guidelines for Antiretroviral Therapy in Kenya. Retrieved June 8, 2018, from https://www.yumpu.com/en/document/read/28407931/guidelines-for-antiretroviral-therapy-in-kenya-4th-edition-2011

Ministry of Health. (2012). Guidelines for Prevention of Mother to Child Transmission (PMTCT) of HIV/AIDS in Kenya. Retrieved June 8, 2018, from https://guidelines.health.go.ke/#/category/27/64/meta

Ministry of Health. (2018). Kenya AIDS Response Progress Report 2018. Retrieved January 25, 2019, from https://www.lvcthealth.org/wp-content/uploads/2018/11/KARPR-Report_2018.pdf

Ministry of Health, & National AIDS and STI Control Programme. (2016). Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya: 2016 Edition. Retrieved June 8, 2018, from https://aidsfree.usaid.gov/sites/default/files/kenya_art_2016.pdf

Ministry of Health, & Programme, N. A. a. S. C. (2015). The Kenya HIV Testing Services Guidelines. Retrieved June 8, 2018, from https://aidsfree.usaid.gov/sites/default/files/hts_policy_kenya_2015.pdf

Ministry of Health, & National AIDS and STI Control Program. (2014). Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: A rapid advice, 2014. Retrieved June 8, 2018, from https://aidsfree.usaid.gov/sites/default/files/tx_kenya_2014.pdf

Newell, M. L., Coovadia, H., Cortina-Borja, M., Rollins, N., Gaillard, P., & Dabis, F. (2004). Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet,364(9441), 1236–1243. https://doi.org/10.1016/s0140-6736(04)17140-7.CrossRefPubMed

Nyandiko, W. M., Otieno-Nyunya, B., Musick, B., Bucher-Yiannoutsos, S., Akhaabi, P., Lane, K., …, Wools-Kaloustian, K. (2010). Outcomes of HIV-exposed children in western Kenya: Efficacy of prevention of mother to child transmission in a resource-constrained setting. Journal of Acquired Immune Deficiency Syndromes, 54(1), 42–50. https://doi.org/10.1097/QAI.0b013e3181d8ad51

Okwara, G. M. F., & Oyore, J. (2015). Determinants of early infant diagnosis and treatment of HIV among exposed infants in informal settlements in Nairobi, Kenya. East and Central Africal Medical Journal, 2, 74–79. Retrieved June 8, 2018, from https://ir-library.ku.ac.ke/handle/123456789/13978

Persaud, D., Gay, H., Ziemniak, C., Chen, Y. H., Piatak, M., Jr., Chun, T. W., …, Luzuriaga, K. (2013). Absence of detectable HIV-1 viremia after treatment cessation in an infant. New England Journal of Medicine, 369(19), 1828–1835. https://doi.org/10.1056/NEJMoa1302976

Sandbulte, M. R., Nazir, N., Goggin, K., Wexler, C., Maloba, M., Gautney, B. J., …, Finocchario-Kessler, S. (2020). Predictors of mortality among HIV-exposed infants through 18 months of age in Kenya: A retrospective review of programmatic data. The Pediatric Infectious Disease Journal, 39(2), 134–136. https://doi.org/10.1097/INF.0000000000002511

SAS Institute, I. (2002–2012). SAS 9.4. Cary, NC, USA. Retrieved June 8, 2018, from https://www.sas.com/en_us/software/sas9.html

Sheahan, A., Feinstein, L., Dube, Q., Edmonds, A., Chirambo, C. M., Smith, E., …, Van Rie, A. (2017). Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed With HIV in the First 12 Weeks of Life: Experiences From Kinshasa, DR Congo and Blantyre, Malawi. The Pediatric Infectious Disease Journal, 36(7), 654–658. https://doi.org/10.1097/inf.0000000000001539

Sridharan, G., Wamalwa, D., John-Stewart, G., Tapia, K., Langat, A., Moraa Okinyi, H., …, Benki-Nugent, S. (2017). High viremia and wasting before antiretroviral therapy are associated with pneumonia in early-treated HIV-infected Kenyan infants. Journal of the Pediatric Infectious Diseases Society, 6(3), 245–252. https://doi.org/10.1093/jpids/piw038

Technau, K. G., Kuhn, L., Coovadia, A., Murnane, P. M., & Sherman, G. (2017). Xpert HIV-1 point-of-care test for neonatal diagnosis of HIV in the birth testing programme of a maternity hospital: A field evaluation study. Lancet HIV,4(10), e442–e448. https://doi.org/10.1016/s2352-3018(17)30097-8.CrossRefPubMedPubMedCentral

UNAIDS. (2018). Country Factsheet: Kenya 2018. Retrieved January 25, 2020, from https://www.unaids.org/en/regionscountries/countries/kenya

UNAIDS. (2019). Global HIV Statistics. Retrieved January 25, 2020, from https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf

Violari, A., Cotton, M. F., Gibb, D. M., Babiker, A. G., Steyn, J., Madhi, S. A., …, McIntyre, J. A. (2008). Early antiretroviral therapy and mortality among HIV-infected infants. New England Journal of Medicine, 359(21), 2233–2244. https://doi.org/10.1056/NEJMoa0800971

Wamalwa, D., Benki-Nugent, S., Langat, A., Tapia, K., Ngugi, E., Slyker, J. A., …, John-Stewart, G. C. (2012). Survival benefit of early infant antiretroviral therapy is compromised when diagnosis is delayed. The Pediatric Infectious Disease Journal, 31(7), 729–731. https://doi.org/10.1097/INF.0b013e3182587796

Watt, M. H., Cichowitz, C., Kisigo, G., Minja, L., Knettel, B. A., Knippler, E. T., …, Mmbaga, B. T. (2019). Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania. AIDS Care, 31(6), 687–698. https://doi.org/10.1080/09540121.2018.1550248

Wexler, C., Cheng, A. L., Gautney, B., Finocchario-Kessler, S., Goggin, K., & Khamadi, S. (2017). Evaluating turnaround times for early infant diagnosis samples in Kenya from 2011–2014: A retrospective analysis of HITSystem program data. PLoS ONE,12(8), e0181005. https://doi.org/10.1371/journal.pone.0181005.CrossRefPubMedPubMedCentral

World Health Organization. (2010). Antiretroviral therapy for HIV infection in infants and children: Recommendations for a public health approach: 2010 revision. Retrieved June 8, 2018, from https://www.who.int/hiv/pub/paediatric/infants2010/en/

World Health Organization. (2016a). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Retrieved June 8, 2018, from https://apps.who.int/iris/bitstream/handle/10665/208825/9789241549684_eng.pdf?sequence=1

World Health Organization. (2016b). WHO Prequalification of In Vitro Diagnostics Public Report. Product: Alere q HIV-1/2 Detect. Retrieved June 8, 2018, from https://www.who.int/diagnostics_laboratory/evaluations/pq-list/hiv-vrl/160613PQPublicReport_0226-032-00AlereHIVDetect_v2.pdf?ua=1

World Health Organization. (2016c). WHO Prequalification of In Vitro Diagnostics Public Report. Product: Xper HIV-1 Qual Assay. Retrieved June 8, 2018, from https://www.who.int/diagnostics_laboratory/evaluations/pq-list/hiv-vrl/160613PQPublicReport_0259-0700-00_XpertQualHIV_v2.pdf

World Health Organization. (2017). Kenya: HIV Country Profile 2017. Retrieved June 8, 2018, from https://cfs.hivci.org/country-factsheet.html

Title: Predictors of Early ART Initiation Among HIV + Infants in Kenya: A Retrospective Review of HITSystem Data from 2013 to 2017
Authors: Catherine Wexler
Niaman Nazir
Brad Gautney
May Maloba
Melinda Brown
Kathy Goggin
Raphael Lwembe
Sarah Finocchario-Kessler
Publication date: 01-06-2020
Publisher: Springer US
Keyword: Human Immunodeficiency Virus
Published in: Maternal and Child Health Journal / Issue 6/2020
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-020-02909-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictors of Early ART Initiation Among HIV + Infants in Kenya: A Retrospective Review of HITSystem Data from 2013 to 2017

Abstract

Objective

Design

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2020

The Association Between Preeclampsia and Childhood Development and Behavioural Outcomes

Is Anemia in Low Income Pregnant Women Related to Their Infants’ Having Anemia? A Cohort Study of Pregnant Women-Infant Pairs in the United States

Family-Centered Management of Birth Defects Diagnosis and Referral in Hospital Settings in Florida

Impact of Perinatal Depression and Anxiety on Birth Outcomes: A Retrospective Data Analysis

Health Care Transition Planning Among Youth with ASD and Other Mental, Behavioral, and Developmental Disorders

Reflections of an Integrated Maternal-Child Health Medical Student Assignment