UNITAID/EGPAF Project: Optimizing Early Infant Diagnosis and Treatment for HIV-infected Infants
Improving early infant diagnosis is critical to initiating treatment promptly for HIV-infected infants and reducing mortality. Globally, more than 1.4 million babies are born to HIV-infected mothers. Peak mortality for infants with HIV occurs between 6 and 8 weeks. While the World Health Organization (WHO) recommends that all children exposed to HIV get tested within the first two months of life, only half of the infants exposed to HIV have access to early infant HIV diagnostic (EID) screening. Fifty percent of infants who are tested never receive their results and therefore cannot be initiated on lifesaving treatment. Without treatment, 80 percent of all children living with HIV die before the age of 5.
In collaboration with UNITAID and other stakeholders, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) developed a flexible and country-driven approach to ensure successful implementation of a complex and ambitious project to expand access to early diagnosis and treatment for HIV-infected infants. This four-year, US $63 million project, aims to increase the number of HIV-positive infants whose HIV status is known in order to facilitate early antiretroviral treatment (ART) initiation. The project will achieve this through the strategic placement of point-of-care EID technologies in nine countries: Cameroon, Côte d’Ivoire, Kenya, Lesotho, Mozambique, Rwanda, Swaziland, Zambia, and Zimbabwe.
Through this project, EGPAF aims to increase the number and percentage of infants and caregivers receiving HIV test results; decrease the turn-around time of results from test to return of result to caregiver; decrease the number of days from HIV diagnosis to ART initiation for HIV-infected infants; and increase the number of children on life-saving treatment.
Strategies in Use
Multiple strategies will be used to optimize existing EID networks in each of these countries, depending on each country’s unique needs, implementation context, and priorities. The project will work with Ministries of Health to identify the most appropriate health facilities for placement of point-of-care platforms to address existing gaps in each of the nine countries.
Working hand-in-hand with each Ministry of Health and other national stakeholders in these countries, EGPAF will undertake activities focused on the following objectives:
- Ensuring that conditions for use of point-of-care EID are met;
- Procuring of point-of-care EID technology;
- Placing point-of-care platforms in selected sites under the direction of the Ministries of Health and according to the national EID network plans;
- Generating and sharing data and evidence with the World Health Organization and other partners; and
- Developing and implementing transition plans in each country, to ensure sustainability of this work within each supported setting.
This initiative aims to increase EID testing coverage in the nine project countries. It will increase the point-of-care EID market share and decrease the cost of EID testing within each of these countries (making HIV testing and diagnosis of infants more accessible). During the four-year project period (August 2015 through July 2019), EGPAF anticipates testing up to 215,000 infants and identifying 30,960 HIV-positive infants. With the assumption that 90% of HIV-positive infants will be initiated on ART and 90% will be virally suppressed, 27,864 HIV-positive infants will be initiated on ART and 25,077 lives will be saved. Through rigorous ongoing evaluation activities, the project will produce and share valuable evidence with the global HIV community regarding the feasibility, utility, and cost of utilizing point-of-care technology for EID.