Mugambi M.L., Deo S., Kekitiinwa A., Kiyaga C., Singer M.E.
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, United States; Indian School of Business, Hyderabad, India; Baylor College of Medicine, Bristol Myers Squibb Children's Clinical Center of Excellence, Mulago Hospital, Kampala, Uganda; AIDS Control Program, Ministry of Health, Kampala, Uganda
Mugambi, M.L., Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, United States; Deo, S., Indian School of Business, Hyderabad, India; Kekitiinwa, A., Baylor College of Medicine, Bristol Myers Squibb Children's Clinical Center of Excellence, Mulago Hospital, Kampala, Uganda; Kiyaga, C., AIDS Control Program, Ministry of Health, Kampala, Uganda; Singer, M.E., Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, United States
Background: There is scant evidence on the association between diagnosis delays and the receipt of test results in HIV Early Infant Diagnosis (EID) programs. We determine the association between diagnosis delays and other health care system and patient factors on result receipt. Methods: We reviewed 703 infant HIV test records for tests performed between January 2008 and February 2009 at a regional referral hospital and level four health center in Uganda. The main outcome was caregiver receipt of the test result. The primary study variable was turnaround time (time between sample collection and result availability at the health facility). Additional variables included clinic entry point, infant age at sample collection, reported HIV status and receipt of antiretroviral prophylaxis for prevention of mother-to-child transmission. We conducted a pooled analysis in addition to separate analyses for each facility. We estimated the relative risk of result receipt using modified Poisson regression with robust standard errors. Results: Overall, the median result turnaround time, was 38 days. 59% of caregivers received infant test results. Caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days or fewer (ARR = 0.83; 95% CI = 0.70-0.98). Caregivers were more likely to receive results at the PMTCT clinic (ARR = 1.81; 95% CI = 1.40-2.33) and less likely at the pediatric ward (ARR = 0.54; 95% CI = 0.37-0.81) compared to the immunization clinic. At the level four health center, result receipt was half as likely among infants older than 9 months compared to 3 months and younger (ARR= 0.47; 95% CI = 0.25-0.93). Conclusion: In this study setting, we find evidence that longer turnaround times, clinic entry point and age at sample collection may be associated with receipt of infant HIV test results. © 2013 Mugambi et al.
antiretrovirus agent; anti human immunodeficiency virus agent; age distribution; article; caregiver; clinic entry point; controlled study; delayed diagnosis; diagnostic error; early diagnosis; evidence based medicine; female; health care system; health center; health program; high risk infant; HIV test; human; Human immunodeficiency virus infection; infant; major clinical study; male; medical parameters; pediatric ward; retrospective study; turnaround time; Uganda; vertical transmission; HIV Infections; newborn; Poisson distribution; post exposure prophylaxis; prevention and control; regression analysis; time; Anti-HIV Agents; Early Diagnosis; Female; HIV Infections; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Poisson Distribution; Post-Exposure Prophylaxis; Regression Analysis; Retrospective Studies; Time Factors; Uganda