POC EID Implementation Models, Linkage to Care & Operational Challenges

Transcription

1 POC EID Implementation Models, Linkage to Care & Operational Challenges 8 TH SA AIDS Conference, June, 2017 ICC Durban, South Africa Reuben Mwenda: MSc (Med Micro), HDMLS, DMLS, CLT ASLM Ambassador Ministry of Health Malawi Government of Malawi

2 Click Available to edit POC EID Master care models title in Malawi stylez Malawi has the following EID POC care models: Pediatric ward model Mother-Infant Pair Clinic (MIP) model Laboratory model

3 Click Available to POC edit EID care Master models in title Malawi stylez (Cont d) These models work because they are supported by: A strong national laboratory network Well defined clinic patient flow Strategic device placement

4 Available POC EID care models in Malawi (Cont d) A strong national POC network: For POC EID the sites rely on conventional laboratories for duplicate testing as EQA National/ Regional Reference Laboratory. Receive duplicate DBS samples from POC sites for EQA (retesting) Tertiary Hospital. POC in out patient and pediatrics District Hospital: Device placed in Laboratory and mother infant clinic Community Hospitals and Large Health Centres: Stand alone POC Health Centre (Public and Private): Shared POC device

5 Available POC EID care models in Malawi (Cont d) Well defined clinic patient flow allows same day results for infants HIV+ mother and infant 1 Enrollment of HEI to HIV care 2 Fill requisition for EID 3 EID test performed on site Test result received, recorded 4 5 Clinical consultation ART initiation 6 7 5

6 Availability of clinicians to link to care at position of POC EID At testing points where clinicians are not available but available within the facility, mother-infant pairs are escorted* to see a clinician ( *By expert clients, mentor mothers, etc.) Availability of clinicians at POC EID testing points POC EID Location Availability of clinicians Pediatric ward Clinicians are readily available Laboratory Mother-Infant Pair Clinic Clinicians are not available. Mothers & their infants are escorted to minimize loss to follow up Clinicians are readily available

7 How POC EID addresses loss to follow-up & linkage to care Conventional EID has multiple clinic visits and longer turnaround times which results in high loss to follow up HIV + mother and infant 1 Visit One Enrollment of HEI in HIV care 2 Fill lab requisition for EID 3 DBS sample collected DBS sample transported to referral lab 4 5 Visit Two DBS sample tested at referral lab 6 Test result transported 7 Test result received, recorded 8 Clinical consultation ART initiation 9 10 Minimum of 2 weeks

8 How POC EID address loss to follow-up & linkage to care (Cnt d) In Malawi there was high LTFU of HEI before the implementation of POC EID ,500 Number of Expected HIV- Exposed Infants 7,992 Number of DNA- PCR Samples Collected and Recorded EID Program Snapshot, Q ~55% of expected HEI ~36% of results returned within 2 months 2,871 Number of EID Results Received at Sites 1,624 Number of EID Results Communicated to Mothers ~57% of results returned to patients Number of Positive EID Results ~48% of infected infants initiated Number of HIV- Infected Infants <12 Mo. Initiated on ART ASLM Abstract Number: , Significantly improved Antiretroviral Therapy initiation rates after the implementation of Point Of Care Early Infant Diagnosis

9 How POC EID address loss to follow-up & linkage to care (Cont d) POC EID minimizes loss to follow up by turning multiple clinic visits into one visit and by reducing the turnaround time to same day results Same day HIV+ Mother and Infant Enrollment of HEI to HIV care Fill lab requisition for EID EID Test performed on site Test result received, recorded Same day Clinical consultation 6 ART initiation 7 9

10 How POC EID address loss to follow-up & linkage to care (Cont d) POC testing allows for significantly reduced test turnaround times along the testing and treatment cascade as well as improved ART initiation rates Centralized POC TAT: sample collection to results received 57 days Same day TAT: sample collection to ART initiation (positive infants only) 40 days Same day Proportion of results received within 30 days 18.1% 100% Proportion of HIV+ patients starting ART 45.8% 91.1% ASLM Abstract Number: , Significantly improved Antiretroviral Therapy initiation rates after the implementation of Point Of Care Early Infant Diagnosis

11 Operational challenges for POC EID Challenges During Implementation of POC EID Tracking ART initiation of referrals When infants are managed by a referring facility Poor documentation and weak linkages Children discharged/transferred out from inpatient care immediately after a test and before initiating treatment Device down times Absence of a local service and maintenance point Short shelf-life of test cartridges Delayed in-patient initiation Current shelf-life for POC cartridges is 9 months as compared to 18 months for HIV rapid test kits Delayed initiation of treatment among HIV-positive infants receiving in-patient care due to unstable medical conditions

12 Recommendations Recommendations for POC EID implementation Tracking ART initiation of referrals Testing facility should initiate HIV positive infants on treatment and advise mothers to collect subsequent refills at the referring facility Poor documentation and weak linkages Intensify training of healthcare workers on proper documentation Institute electronic patient tracking systems Device down times Build and strengthen local capacity Short shelf-life of test cartridges Advocate for longer shelf-life (18 months) Delayed in-patient initiation Follow up patients to make sure that there is no delay in initiation of treatment as soon as the patient gets stable

13 Agenda Feedback? Questions? Zikomo! Thank You!