Feasibility of early infant diagnosis of HIV in resource-limited settings: the ANRS 12140-PEDIACAM study in Cameroon

Mathurin C Tejiokem, Albert Faye, Ida C Penda, Georgette Guemkam, Francis Ateba Ndongo, Gisèle Chewa, Claire Rekacewicz, Dominique Rousset, Anfumbom Kfutwah, Pascal Boisier, Josiane Warszawski, ARNS 12140-PEDIACAM study group, Albert Faye, Mathurin Cyrille Tejiokem, Françoise Barré-Sinoussi, Daniel Scott, Frédéric Tangy, Laurence Baril, Josiane Warszawski, Stéphane Blanche, Catherine Dollfus, Pascal Boisier, Anfumbom Kfutwah, Ida Penda, Georgette Guemkam, Ateba Ndongo Francis, Gisèle Chewa, Pascaline Maffo, Paul Alain Ngoupo, Félicité Owona, Régis Pouillot, Dominique Rousset, Patrice Tchendjou, Martial Yonga, Jean Marie Ehongo, Serge Ela, Robert Leke, Patricia Mbida, Jean Audrey Ndongo, Jeanne Ngozi, Claire Ndongo, Gilbert Tene, Paul Koki, Marie Louise Belinga, Dieudonné Evoundou, Annie Nga, Suzanne Nguen, Suzie Tetang, Guillaume Wamba, Zeudja, Julie Djene, Nicaise Makwet, Madeleine Mbangué, Mary Nfor, Aurore Ngo Sohna, Ngwa, Hermine Nyemb, Shiro Obedat, Gérémie Solle, Cassandre Tocko, Mathurin C Tejiokem, Albert Faye, Ida C Penda, Georgette Guemkam, Francis Ateba Ndongo, Gisèle Chewa, Claire Rekacewicz, Dominique Rousset, Anfumbom Kfutwah, Pascal Boisier, Josiane Warszawski, ARNS 12140-PEDIACAM study group, Albert Faye, Mathurin Cyrille Tejiokem, Françoise Barré-Sinoussi, Daniel Scott, Frédéric Tangy, Laurence Baril, Josiane Warszawski, Stéphane Blanche, Catherine Dollfus, Pascal Boisier, Anfumbom Kfutwah, Ida Penda, Georgette Guemkam, Ateba Ndongo Francis, Gisèle Chewa, Pascaline Maffo, Paul Alain Ngoupo, Félicité Owona, Régis Pouillot, Dominique Rousset, Patrice Tchendjou, Martial Yonga, Jean Marie Ehongo, Serge Ela, Robert Leke, Patricia Mbida, Jean Audrey Ndongo, Jeanne Ngozi, Claire Ndongo, Gilbert Tene, Paul Koki, Marie Louise Belinga, Dieudonné Evoundou, Annie Nga, Suzanne Nguen, Suzie Tetang, Guillaume Wamba, Zeudja, Julie Djene, Nicaise Makwet, Madeleine Mbangué, Mary Nfor, Aurore Ngo Sohna, Ngwa, Hermine Nyemb, Shiro Obedat, Gérémie Solle, Cassandre Tocko

Abstract

Background: Early infant diagnosis (EID) of HIV is a key-point for the implementation of early HAART, associated with lower mortality in HIV-infected infants. We evaluated the EID process of HIV according to national recommendations, in urban areas of Cameroon.

Methods/findings: The ANRS12140-PEDIACAM study is a multisite cohort in which infants born to HIV-infected mothers were included before the 8(th) day of life and followed. Collection of samples for HIV DNA/RNA-PCR was planned at 6 weeks together with routine vaccination. The HIV test result was expected to be available at 10 weeks. A positive or indeterminate test result was confirmed by a second test on a different sample. Systematic HAART was offered to HIV-infected infants identified. The EID process was considered complete if infants were tested and HIV results provided to mothers/family before 7 months of age. During 2007-2009, 1587 mother-infant pairs were included in three referral hospitals; most infants (n = 1423, 89.7%) were tested for HIV, at a median age of 1.5 months (IQR, 1.4-1.6). Among them, 51 (3.6%) were HIV-infected. Overall, 1331 (83.9%) completed the process by returning for the result before 7 months (median age: 2.5 months (IQR, 2.4-3.0)). Incomplete process, that is test not performed, or result of test not provided or provided late to the family, was independently associated with late HIV diagnosis during pregnancy (adjusted odds ratio (aOR) = 1.8, 95%CI: 1.1 to 2.9, p = 0.01), absence of PMTCT prophylaxis (aOR = 2.4, 95%CI: 1.4 to 4.3, p = 0.002), and emergency caesarean section (aOR = 2.5, 95%CI: 1.5 to 4.3, p = 0.001).

Conclusions: In urban areas of Cameroon, HIV-infected women diagnosed sufficiently early during pregnancy opt to benefit from EID whatever their socio-economic, marital or disclosure status. Reduction of non optimal diagnosis process should focus on women with late HIV diagnosis during pregnancy especially if they did not receive any PMTCT, or if complications occurred at delivery.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Take-up and key points of…
Figure 1. Take-up and key points of early infant HIV diagnosis process (ANRS12140-Pediacam study, Cameroon, 2007–2009).

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Source: PubMed

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