Implementing services for Early Infant Diagnosis (EID) of HIV: a comparative descriptive analysis of national programs in four countries

<p>Abstract</p> <p>Background</p> <p>There is a significant increase in survival for HIV-infected children who have early access to diagnosis and treatment. The goal of this multi-country review was to examine when and where HIV-exposed infants and children are being diagnosed, and whether the EID service is being maximally utilized to improve health outcomes for HIV-exposed children.</p> <p>Methods</p> <p>In four countries across Africa and Asia existing documents and data were reviewed and key informant interviews were conducted. EID testing data was gathered from the central testing laboratories and was then complemented by health facility level data extraction which took place using a standardized and validated questionnaire</p> <p>Results</p> <p>In the four countries reviewed from 2006 to 2009 EID sample volumes rose dramatically to an average of >100 samples per quarter in Cambodia and Senegal, >7,000 samples per quarter in Uganda, and >2,000 samples per quarter in Namibia. Geographic coverage of sites also rapidly expanded to 525 sites in Uganda, 205 in Namibia, 48 in Senegal, and 26 in Cambodia in 2009. However, only a small proportion of testing was done at lower-level health facilities: in Uganda Health Center IIs and IIIs comprised 47% of the EID collection sites, but only 11% of the total tests, and in Namibia 15% of EID sites collected >93% of all samples. In all countries except for Namibia, more than 50% of the EID testing was done after 2 months of age. Few sites had robust referral mechanisms between EID and ART. In a sub-sample of children, we noted significant attrition of infants along the continuum of care post testing. Only 22% (Senegal), 37% (Uganda), and 38% (Cambodia) of infants testing positive by PCR were subsequently initiated onto treatment. In Namibia, which had almost universal EID coverage, more than 70% of PCR-positive infants initiated ART in 2008.</p> <p>Conclusions</p> <p>While EID testing has expanded dramatically, a large proportion of PCR- positive infants are initiated on treatment. As EID services continue to scale-up, more programmatic attention and support is needed to retain HIV-exposed infants in care and ensure that those testing positive initiate treatment in a timely manner. Namibia's experience demonstrates that it is feasible for a rural, low-income country to achieve high national coverage of infant testing and treatment.</p

Hemoglobin variants identified in the Uganda Sickle Surveillance Study

The Uganda Sickle Surveillance Study analyzed dried blood spots that were collected from almost 100 000 infants and young children from all 10 regions and 112 districts in the Republic of Uganda, with the primary objective of determining the prevalence of sickle cell trait and disease. An overall prevalence of 13.3% sickle cell trait and 0.7% sickle cell disease was recently reported. The isoelectric focusing electrophoresis technique coincidentally revealed numerous hemoglobin (Hb) variants (defined as an electrophoresis band that was not Hb A, Hb F, Hb S, or Hb C) with an overall country-wide prevalence of 0.5%, but with considerable geographic variability, being highest in the northwest regions and districts. To elucidate these Hb variants, the original isoelectric focusing (IEF) gels were reviewed to identify and locate the variant samples; corresponding dried blood spots were retrieved for further testing. Subsequent DNA-based investigation of 5 predominant isoelectric focusing patterns identified 2 α-globin variants (Hb Stanleyville II, Asn78Lys; Hb G-Pest, Asp74Asn), 1 β-globin variant (Hb O-Arab, Glu121Lys), and 2 fusion globin variants (Hb P-Nilotic, β31-δ50; Hb Kenya, Aγ81Leu-β86Ala). Compound heterozygotes containing an Hb variant plus Hb S were also identified, including both Hb S/O-Arab and HbS/Kenya. Regional differences in the types and prevalence of these hemoglobin variants likely reflect tribal ancestries and migration patterns. Algorithms are proposed to characterize these Hb variants, which will be helpful for emerging neonatal hemoglobinopathy screening programs that are under way in sub-Saharan Africa

Inclusive education for deaf students: literacy practices and South African sign language

This is an Accepted Manuscript of an article published by Taylor & Francis in Southern African Linguistics and Applied Language Studies on 16 July 2012, available online: http://www.tandfonline.com/10.2989/16073614.2012.693707.This article considers the feasibility of inclusive education for Deaf students in a mainstream Further Education and Training (FET) classroom through the use of a South African Sign Language interpreter. It revisits the centrality of language in Deaf students' education and reports on progressive policy changes in the areas of language, education and disability in South Africa. The article surveys classroom discourse and literacy practices in a mainstream FET classroom, focusing particularly on students' acquisition of text literacy skills in Business English. Drawing on theoretical frameworks from the New Literacy Studies, Critical Discourse Analysis and the Social Model of Disability, the article argues that there is definitely potential for establishing inclusive education for Deaf students in a mainstream classroom. It however highlights that there are many difficulties and challenges around providing fully inclusive education for Deaf students. It was found that the signed interpretations in this classroom frequently represent an impoverished form of language while some types of pedagogic practice impede the interpreter's signing. The article concludes that interpreters and teachers need to be trained in forms of language and pedagogy that would benefit all students in class, including Deaf students

Cost for sickle cell disease screening using isoelectric focusing with dried blood spot samples and estimation of price thresholds for a point-of-care test in Uganda

Mercy Mvundura,1 Charles Kiyaga,2 Mutsumi Metzler,1 Carol Kamya,3 Jeanette M Lim,1 Catherine Maiteki-Sebuguzi,4 Patricia S Coffey1 1Devices and Tools Global Program, PATH, Seattle, WA, USA; 2Uganda Central Public Health Laboratory, Ministry of Health, Kampala, Uganda; 3Evaluation Projects, Infectious Diseases Research Collaboration, Kampala, Uganda; 4Independent Consultant, Kampala, Uganda Background: Early identification through newborn screening is the first step in active management of sickle cell disease (SCD). Uganda currently screens newborns and infants under 2 years for SCD in high HIV-burden districts using isoelectric focusing with dried blood spot samples. Our analysis sought to estimate the costs per child screened for SCD using this method in Uganda and then to use those data to estimate the price threshold for screening with a point-of-care (POC) test. Methods: We estimated the financial and economic costs per child screened for SCD using data from health facilities and the Central Public Health Laboratory. These costs included sample collection, transportation, and laboratory processing. Price thresholds for a POC test were estimated using two scenarios. Results: The price threshold of an SCD POC test used for diagnosis would be $3.77 when taking into account only financial costs and$5.14 when taking into account economic costs. Thresholds for a POC test used for screening would be 3.07–3.51 and 4.38–5.09, respectively, depending on test specificity. Conclusion: The price threshold of a POC test for SCD will depend on the assumptions on how it will be used &ndash; either as a screening or diagnostic test. If used for screening, test specificity will have significant impact. Results from this type of costing study can allow developers to incorporate quantitatively estimated price thresholds for innovative products into target product profiles early in the product development cycle. Keywords: point-of-care, sickle cell disease, costing, Uganda, diagnostics, screenin