Universal HIV Screening at Postnatal Points of Care: Which Public Health Approach for Early Infant Diagnosis in Côte d’Ivoire?

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Study Justification:
The study aimed to assess the acceptability of universal HIV screening for infants at postnatal points of care (PPOC) in Abidjan, Côte d’Ivoire. This approach is important for early infant diagnosis (EID) of HIV and can help in providing timely care and treatment for HIV-infected infants.
Highlights:
– The study provided 3,013 HIV tests for infants and their mothers.
– While 58% of mothers accepted the principle of EID, only 15% of infants had formal parental consent for testing.
– Among the 81 HIV-exposed children, 52% had parental consent and were tested, with 11.9% testing positive for HIV.
– Fathers’ acceptance rate for EID remained very low.
– Maternal acceptance of EID was strongly correlated with prenatal self-reported HIV status.
Recommendations:
– Focus on increasing the coverage of prevention of mother-to-child transmission (PMTCT) programs.
– Involve fathers in the decision-making process and encourage their participation in EID.
– Improve the tracing of children born to mothers enrolled in PMTCT programs.
– Enhance awareness and education about HIV testing and EID for both parents and caregivers.
Key Role Players:
– Health care workers: Trained counselors and health care providers who offer HIV screening and counseling services.
– Parents/caregivers: They play a crucial role in providing consent for HIV testing and participating in EID.
– Policy makers: Responsible for implementing and supporting programs related to HIV screening and EID.
– Community leaders and organizations: They can help in raising awareness and promoting acceptance of EID.
Cost Items for Planning Recommendations:
– Training and capacity building for health care workers.
– Development and distribution of educational materials.
– Outreach and awareness campaigns.
– Transportation and logistics for tracing children and providing HIV care.
– Monitoring and evaluation of program effectiveness.
Please note that the cost items mentioned are for planning purposes and not actual costs. The actual budget would depend on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some limitations. The study was a cross-sectional evaluation, which may limit the ability to establish causation. Additionally, the study was conducted in 2008, so the findings may not be applicable to current situations. To improve the evidence, future studies could consider using a longitudinal design to better understand the acceptability of universal HIV screening at postnatal points of care. Additionally, conducting the study in more recent years would provide more up-to-date information.

Background:Universal HIV pediatric screening offered at postnatal points of care (PPOC) is an entry point for early infant diagnosis (EID). We assessed the parents’ acceptability of this approach in Abidjan, Côte d’Ivoire.Methods:In this cross-sectional study, trained counselors offered systematic HIV screening to all children aged 6-26 weeks attending PPOC in three community health centers with existing access to HAART during 2008, as well as their parents/caregivers. HIV-testing acceptability was measured for parents and children; rapid HIV tests were used for parents. Both parents’ consent was required according to the Ivorian Ethical Committee to perform a HIV test on HIV-exposed children. Free HIV care was offered to those who were diagnosed HIV-infected.Findings:We provided 3,013 HIV tests for infants and their 2,986 mothers. While 1,731 mothers (58%) accepted the principle of EID, only 447 infants had formal parental consent 15%; 95% confidence interval (CI): [14%-16%]. Overall, 1,817 mothers (61%) accepted to test for HIV, of whom 81 were HIV-infected (4.5%; 95% CI: [3.5%-5.4%]). Among the 81 HIV-exposed children, 42 (52%) had provided parental consent and were tested: five were HIV-infected (11.9%; 95% CI: [2.1%-21.7%]). Only 46 fathers (2%) came to diagnose their child. Parental acceptance of EID was strongly correlated with prenatal self-reported HIV status: HIV-infected mothers were six times more likely to provide EID parental acceptance than mothers reporting unknown or negative prenatal HIV status (aOR: 5.9; 95% CI: [3.3-10.6], p = 0.0001).Conclusions:Although the principle of EID was moderately accepted by mothers, fathers’ acceptance rate remained very low. Routine HIV screening of all infants was inefficient for EID at a community level in Abidjan in 2008. Our results suggest the need of focusing on increasing the PMTCT coverage, involving fathers and tracing children issued from PMTCT programs in low HIV prevalence countries. © 2013 Ndondoki et al.

The study was approved by the Ivoirian Ethical Committee (March 2008). The National Ethics Committee, in reference to the law of the civil code n°70–453 of 3 August 1970 on minorities in Cote d’Ivoire, specified that “HIV-testing and care for children who are enrolled in any clinical research study must be conditioned by mutual and written informed consent of both their father and mother.” The PEDI-TEST ANRS 12165 Study was a cross-sectional evaluation of both health care workers and family- acceptability of routine HIV pediatric counseling and testing (CT) as the entry point of a family screening strategy. The study was conducted at three community health facilities (General Hospital of Bonoua, Urban Health Facility of Koumassi and Urban Health Facility of Abobo Avocatier) in Abidjan, Côte d’Ivoire. The study on health care workers acceptability towards routine infant HIV testing was reported elsewhere [24]. Since 2004, those health centers offer comprehensive HIV/AIDS care and treatment program, including HIV voluntary counseling and testing services, PMTCT services, and antiretroviral treatment for children and adults infected by HIV. Any child aged 6–26 weeks attending postnatal care at any pediatric service (immunization, weighing and consultation) in either three centers, was eligible for this study with four sequential contacts over a three-month period. Their parents/caregivers (mother, father, caregiver or legal guardian) were also eligible for this survey. At the first contact, trained counselors offered systematic early infant diagnosis to index children and an HIV CT to their mother/parents/caregiver. Counselors translated and explained the study information sheet in mother -tongue to illiterate women. The process of the HIV testing method, return appointments, and provision of results was explained by trained counselors to each caregiver who agreed to participate in the study. An HIV serology was first performed for mothers who accepted their own test. Each mother was encouraged to discuss infant testing with the child’s father or legal guardian before formal acceptance of EID. Mothers returned at home with the study information sheet and the consent form, in order to present them to their partner or the child’s legal guardian. At the second contact two weeks later, the mother’s result was disclosed to her with confidentiality, if she was tested. We collected the parental consent for EID independently of the HIV mother’s status. Then, we performed an HIV testing for all HIV exposed infants for those whose both parents (or legal guardian) had given written informed consent, as required by the Ivoirian Ethical Committee. Children whose mother was either tested HIV-positive at the first contact or HIV-unknown first had a serology before HIV PCR testing. Children whose mother was tested as HIV-uninfected at the first contact were not tested at all, assuming that at this age (20% in univariate analysis. The final model was obtained using a backward-stepwise strategy with consideration for interaction and cofounding. The criterion for the statistical significance was set at an α of 0.05. Statistical analysis was performed using SAS 9.1 (TS1M3). The qualitative analysis of parental interviews was done thematically by an inductive approach.

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The study mentioned in the description focuses on the acceptability of universal HIV screening for infants and their parents/caregivers at postnatal points of care (PPOC) in Côte d’Ivoire. The goal is to improve early infant diagnosis (EID) and access to HIV care for children. Some potential innovations or recommendations to improve access to maternal health based on this study could include:

1. Increasing awareness and education: Implementing targeted awareness campaigns to educate parents and caregivers about the importance of EID and the benefits of early HIV diagnosis and treatment for infants.

2. Engaging fathers and partners: Developing strategies to involve fathers and partners in the decision-making process regarding EID and HIV testing for infants. This could include providing information and counseling specifically tailored for fathers and encouraging their active participation in the testing process.

3. Strengthening PMTCT programs: Enhancing prevention of mother-to-child transmission (PMTCT) programs to ensure that all pregnant women have access to HIV testing and counseling during prenatal care. This can help identify HIV-positive mothers early and provide appropriate interventions to prevent transmission to their infants.

4. Improving healthcare worker training: Providing comprehensive training for healthcare workers on EID, HIV testing, and counseling to ensure they have the knowledge and skills to effectively communicate with parents and caregivers about the importance of testing and treatment for infants.

5. Addressing barriers to testing: Identifying and addressing barriers that may prevent parents and caregivers from consenting to HIV testing for their infants, such as stigma, fear, or lack of understanding. This could involve providing additional support, counseling, or incentives to encourage participation.

6. Strengthening healthcare systems: Investing in the infrastructure and resources needed to support universal HIV screening and EID at PPOC, including laboratory facilities for testing and treatment services for HIV-positive infants.

7. Collaboration and coordination: Promoting collaboration and coordination among healthcare providers, community organizations, and government agencies to ensure a comprehensive and integrated approach to maternal and child health, including HIV testing and treatment.

It is important to note that these recommendations are based on the specific context and findings of the study mentioned and may need to be adapted to the local context and resources available in other settings.
AI Innovations Description
The recommendation from the study is to focus on increasing the coverage of Prevention of Mother-to-Child Transmission (PMTCT) programs, involving fathers, and tracing children born to mothers who have received PMTCT services. This approach aims to improve access to maternal health by addressing the low acceptance rate of early infant diagnosis (EID) for HIV.

The study found that while the principle of EID was moderately accepted by mothers, the acceptance rate among fathers remained very low. The study suggests that increasing the involvement of fathers in the decision-making process and providing them with information about the importance of EID could help improve acceptance rates.

Additionally, the study highlights the need to increase the coverage of PMTCT programs. By ensuring that more pregnant women have access to HIV testing and counseling during pregnancy, the study suggests that the acceptance of EID could be improved. This approach would involve integrating PMTCT services into routine antenatal care and providing comprehensive support for HIV-positive pregnant women.

Furthermore, the study recommends tracing children born to mothers who have received PMTCT services. By actively following up with these children and their families, healthcare providers can ensure that they receive the necessary care and support, including early infant diagnosis for HIV.

Overall, the recommendation is to implement a comprehensive approach that includes increasing PMTCT coverage, involving fathers, and tracing children born to mothers who have received PMTCT services. This approach aims to improve access to maternal health and increase acceptance rates for early infant diagnosis of HIV.
AI Innovations Methodology
Based on the information provided, the study conducted in Côte d’Ivoire aimed to assess the acceptability of universal HIV screening for infants at postnatal points of care (PPOC) as a means of early infant diagnosis (EID). The study found that while the principle of EID was moderately accepted by mothers, the acceptance rate among fathers remained very low. The study suggests the need to focus on increasing prevention of mother-to-child transmission (PMTCT) coverage, involving fathers, and tracing children from PMTCT programs in low HIV prevalence countries.

To improve access to maternal health, here are some potential recommendations:

1. Increase PMTCT coverage: Strengthen efforts to ensure that pregnant women receive adequate prenatal care, including HIV testing and counseling, to prevent mother-to-child transmission of HIV.

2. Engage fathers: Develop strategies to actively involve fathers in maternal health programs, including HIV screening and counseling, to increase their awareness and support for the health of both the mother and the child.

3. Improve education and awareness: Implement comprehensive education and awareness campaigns targeting communities, healthcare providers, and pregnant women about the importance of maternal health, including HIV screening and prevention.

4. Enhance healthcare infrastructure: Invest in improving healthcare infrastructure, particularly in low-resource settings, to ensure that maternal health services, including HIV screening and treatment, are accessible and of high quality.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that will be affected by the recommendations, such as pregnant women, healthcare providers, or community members.

2. Collect baseline data: Gather data on the current state of access to maternal health services, including HIV screening and prevention, in the target population. This could include information on the number of women receiving prenatal care, HIV testing rates, and the availability of healthcare facilities.

3. Develop a simulation model: Create a simulation model that incorporates the key variables and factors related to access to maternal health. This could include factors such as the number of healthcare facilities, the availability of trained healthcare providers, and the level of community awareness and engagement.

4. Define scenarios: Define different scenarios based on the recommendations, such as increasing PMTCT coverage by a certain percentage, implementing father engagement programs, or improving healthcare infrastructure. Each scenario should include specific changes to the variables in the simulation model.

5. Simulate the impact: Run the simulation model using the defined scenarios to estimate the potential impact of the recommendations on improving access to maternal health. This could include measures such as the increase in the number of women receiving prenatal care, the reduction in HIV transmission rates, or the improvement in healthcare facility accessibility.

6. Analyze and interpret the results: Analyze the simulation results to understand the potential impact of the recommendations on improving access to maternal health. Compare the different scenarios to identify the most effective strategies and prioritize implementation.

7. Validate the results: Validate the simulation results by comparing them with real-world data and feedback from stakeholders, such as healthcare providers and community members. This will help ensure the accuracy and reliability of the simulation model.

By following this methodology, policymakers and healthcare stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health and make informed decisions on implementing effective interventions.

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