Pilots have shown that early infant diagnosis
can be moved closer to point of care
by David Jamieson
We have known for years that if babies born with HIV do not receive treatment, more than 50 percent will die before their second birthday, but we also know that when treated, they can grow into healthy adults. Until very recently, a big challenge has been reaching mothers and their new babies soon enough, testing baby, and getting the results back to mom. Reliable diagnosis could only be completed in larger laboratories, meaning blood samples had to be transported to the lab, kept fresh for testing, and then the results returned — by which time, mother and baby were probably back in their village and might never get the result.
Recent work by WHO, CDC, and UNITAID means that this is all about to change. WHO and CDC have pre-qualified two point-of-care (POC) instruments: the Alere™q and the Cepheid GeneXpert® (both are and WHO Prequalified). And UNITAID is funding an Early Infant Diagnosis (EID) Consortium, initially to pilot test POC EID in Kenya, Malawi, Mozambique, Tanzania, South Africa, and Zimbabwe, and then to scale up the model if the pilot proved the concept.
The great news is that, yes, the pilot was successful, and as the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) reports, now is the time to accelerate scale-up and usage. UNITAID’s EID Consortium, EGPAF, Clinton Health Access Initiative (CHAI), UNICEF, and Médecins Sans Frontières (MSF) are now working with local governments and stakeholders to get the rollout moving, but we can all be involved.
Although these new instruments get a lot closer to mother and baby, it is not practical to put a machine in every location. The experience of the rollout of CD4 POC instruments is that many lay idle for long periods because of low demand. With EID, it will be important to learn the lessons from CD4. One thing that is clear is that to accelerate EID, we will need multiple inputs from many stakeholders.
How PFSCM can contribute to scaling up POC EID
PFSCM has always been firmly committed to improving the care, detection, and treatment of the youngest patients. Drawing on our expertise in managing global supply chains and optimizing laboratory networks, our contribution will be to ensure that the supply chain doesn’t let these patients down; that smart network design places these new instruments where they will make the most difference; and that results get back to mom and her health caregivers at the earliest opportunity. Specifically, we can:
- Use software and GIS technology to design smart networks of laboratory-based instruments and POC diagnostics to reach as many mothers and babies as possible;
- Consolidate supply chains to deliver complete packages of commodities needed for each and every test; and
- Apply our expertise in data management and mobile technology to get the results back to mother and baby quickly.
The growing success of PMTCT (prevention of mother-to-child transmission) means that fewer babies are being born with HIV, but for those who are, EID is essential. And PFSCM can help ensure that pediatric antiretrovirals (ARVs) are available to treat babies born with HIV. (We will cover pediatric treatment in subsequent blog posts.)
PFSCM strongly supports the goal of an AIDS-free generation, and the three “frees” — start free, stay free, AIDS free.