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A study on time gap analysis between early infant diagnosis (EID) and initiation of antiretroviral treatment (ART) among HIV-exposed infants from Ahmedabad, Gujarat, India

Kamleshkumar Jain, Venu Shah, Umesh N Oza, Kantilal N Sonaliya.


Background: Effective pediatric HIV management requires early diagnosis and prompt initiation of antiretroviral treatment (ART) to ensure optimum quality care. ART initiation in the first 3 months of life can reduce mortality by 76%. Delay at any step from the collection of blood sample to the ART registration will lead to a delayed initiation of ART.

Objective: To analyze the time gap in each step of HIV testing and ART initiation and analyze the median age of ART initiation among the HIV-exposed infants.

Materials and Methods: This retrospective, cohort study was conducted from the record of Ahmedabad Municipal Corporation AIDS Control Society (AMCACS). A total 488 infants born to HIV-positive mothers were registered since 2010 in AMC ACS till June 2014. Time gap analysis for each process starting from HIV testing to ART initiation was carried out using Microsoft Excel.

Result: Among all the infants (465) tested by either method, 32 (6.8%) of those who were reactive were followed up subsequently. Of them, three died and three were nonreactive by whole blood specimen (WBS) test, while another three cases were lost to follow-up. The median age for carrying out dry blood spot (DBS) test in this study was 8 weeks. The median time for DBS and WBS testing was 3 weeks and 1 week, respectively, whereas the median time from DBS to initiation of ART was 10 weeks. The median time from birth to ART initiation was 37 weeks.

Conclusion: Time lag was present at all the stages from the commencement of DBS examination to ART initiation.

Key words: Early infant diagnosis, antiretroviral treatment (ART) initiation, time lag

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