New 9 Month Rapid Test

Yes yes...I'm still actually working over here in Uganda...thought it might be time to give you all a work-related update :)

​CHAI is supporting the Ministry of Health pilot a 9 month rapid antibody test as part of the EID (early infant diagnosis) testing algorithm. The goal is to identify HIV+ infants as soon as possible so they can start on treatment immediately. 

Currently, the guidelines say that healthcare workers should do a 1st DNA PCR (polymerase chain reaction)at 6 weeks and then a 2nd DNA PCR 6 weeks after the mother stops breastfeeding (usually just over a year). While the infants are young, they carry maternal antibodies, so the tests look at an infant's DNA directly. At or after 18 months, infants will be given a rapid antibody test which is the same test an adult would receive. 

Rapid tests are cheaper and easier to perform compared to DNA PCR tests which require removal of hemoglobin from the blood in order to obtain leukocytes from which purified genomic DNA is isolated. While facilities can perform their own rapid tests, DNA PCR test samples are collected at the facilities, delivered by hub riders to the local post office and run in the central lab in Kampala. The turn around time (TAT) for results is approximately 2 weeks. While the TAT has decreased over the past few years thanks to some hard work from our labs team, any TAT at all increases the risk of mothers and caregivers not coming back to pick up their results.
 
Introducing a 9 month test between the 1st and 2nd DNA PCR would help identify exposed infants who seroconvert (basically means they weren't showing signs of the virus but now are) after a negative 1st DNA PCR. Additionally, there have been some studies showing that maternal antibodies usually clear by 9-12 months (though they can remain until 18 months and in mothers who continue to breast feed). Lastly, the uptake of the measles vaccine, which is administered at 9 months, is around 95% in Uganda, so the hope is to capitalize on the fact that mothers are bringing their children to the facilities already.
 
The pilot will help us gain insights into the operational challenges we will encounter (and yes, there will be many) so that we can apply lessons learned to the scale-up process. We trained healthcare workers in February and are doing some data collection right now so hopefully we'll see strong uptake of the 9 month test!

Here are the current (left) and proposed (right) testing algorithms in case you're interested.