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Early Infant Diagnosis using DBS: highlighting challenges

This presentation by Denis Tindyebwa, Director of Pediatric Care and Treatment at the Elizabeth Glaser Pediatric AIDS Foundation, explores the critical challenges in Early Infant Diagnosis (EID) of HIV using dried blood spots (DBS). It highlights alarming statistics, such as the low percentage of PMTCT sites offering EID services, inadequate testing of exposed infants, and the gaps in linking mothers to tested infants. The need for improved specimen collection, clear Standard Operating Procedures, and better integration of services is emphasized to ensure all infants receive comprehensive care and timely treatment.

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Early Infant Diagnosis using DBS: highlighting challenges

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  1. Early Infant Diagnosis using DBS: highlighting challenges Denis Tindyebwa Director Pediatric Care and Treatment Elizabeth Glaser Pediatric AIDS Foundation

  2. EID Reaching children “missed” by PMTCT

  3. Identifying and testing exposed infant • Only 10-50% PMCTC sites offer EID services • Less than 50% exposed children tested • Less than 20% of PMTCT mothers linked to tested infants • Average age at 1st DBS is over 6 months – only 40% tested within 3 months • Very few exposed children identified in MCH, Ped wards, OPD • Going beyond specimen collection and checking basic clinical parameters – weight, etc

  4. Taking specimens - DBS • Who orders the test, now & later • Clear simple SOPs • No of staff able to take specimen; • Task shifting? • Quality of specimens; • Feedback to sites on quality of specimen

  5. Going beyond doing PCR testing • 10% exposed children started on CTX within 8 weeks • 35% infants receiving results never enrolled in care • 54% Infants enrolled in care not started on ART

  6. DBS PCR Cascade July 08 –April 2009

  7. Conclusion • Implementation of EID requires an integrated approach • Planning and program implementation should always keep focus on intended outcome • Newer technologies; simpler, cheaper better

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