Illustrative quotes by women and health workers on VEID acceptability.

<p>Illustrative quotes by women and health workers on VEID acceptability.</p

Illustrative quotes by women, health workers and laboratory personnel on VEID feasibility.

<p>Illustrative quotes by women, health workers and laboratory personnel on VEID feasibility.</p

Illustrative quotes by women and health workers on VEID acceptability.

<p>Illustrative quotes by women and health workers on VEID acceptability.</p

Exposure to HIV-1 replication and PBMC HIV-1 DNA levels one year following cART.

<p>The estimated 12 month AUC was significantly positively associated with HIV-1 DNA levels at one year (r = 0.51, p = 0.004).</p

Study Cohort: Pre-therapy Viral Load, CD4%, and Therapeutic Regimens^a.

<p>Study Cohort: Pre-therapy Viral Load, CD4%, and Therapeutic Regimens<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0154391#t001fn001" target="_blank">^a</a>.</p

Estimation of PBMC HIV-1 DNA Decline.

<p><b>a) Estimation of PBMC HIV-1 DNA Decline in All Children over the First Year of cART</b>. ET (closed circle and solid line) and LT children (open circle and dashed line) experienced a significant decline in PBMC HIV-1 DNA after one year of cART (-1.04±0.11 log₁₀ DNA copies per million PBMC, p<0.001 in ET and -0.74 ±0.13 log₁₀ DNA copies per million PBMC, p<0.001 in LT). <b>b) Estimation of PBMC HIV-1 DNA Decline in Children with Controlled HIV-1 Replication</b>. ET (closed circle and solid line) and LT children (open circle and dashed line) experienced a marked decline in PBMC HIV-1 DNA levels in the first year of cART (-1.03±0.12 log₁₀, p<0.001 in ET and -0.82±0.16 log₁₀, p<0.001 in LT), but the rates of decline did not differ significantly between ET and LT (p = 0.3). Similarly, in years 1 through 4 of cART, PBMC HIV-1 DNA levels continued to decline significantly in both the ET (p<0.001) and LT groups (p<0.001), but the decline slopes were not statistically significantly different between the groups.</p

Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks?

<div><p>Introduction</p><p>Early infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade.</p><p>Methods</p><p>We conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means (with 95% CI) were calculated and compared by region using linear mixed models.</p><p>Results</p><p>1,187 individual infant records from 25 facilities were reviewed. Overall, early infant diagnosis turnaround time was 61.7 days (95%CI: 55.3–68.7). Mean time from specimen collection to district laboratory was 14 days (95%CI: 12.1–16.1); from district to central laboratory, 2 days (95%CI 0.8–5.2); results from central laboratory to district hospital, 23.3 days (95%CI: 18.7–29.0); from district hospital to health facility, 3.2 days (95%CI 1.9–5.5); and from health facility to caregiver, 10.4 days (95%CI, 7.9–13.5). Mean times from specimen transfer to the central laboratory and for result transfer from central laboratory to district hospital were significantly shorter in the Lowlands Region (0.9 and 16.2 days, respectively), compared to Highlands Region (6.0 [P = 0.030] and 34.3 days [P = 0.0099]. Turnaround time from blood draw to receipt of results was significantly shorter for HIV infected infants compared to HIV uninfected infants [p = 0.0036] at an average of 47.1 days (95%CI: 38.9–56.9) and 62 days (95%CI: 55.9–68.7) respectively. Of 47 HIV-infected infants, 36 were initiated on antiretroviral therapy at an average of 1.3 days (95%CI: 0.3, 5.7) after caregiver received the result.</p><p>Conclusion</p><p>HIV-infected infants received results earlier and were rapidly initiated on antiretroviral therapy once the result was delivered to caregiver. However, average early infant diagnosis turnaround time was two months; the longest period of delay was transfer of results from central laboratory to district hospital. Turnaround time of results based on geographical regions or between hospitals and health centres varied but did not reach statistical significance.</p></div

One possible clinical pathway for testing monoclonal antibodies in infants.

<p>Safety, pharmacokinetics (PK), and biological effect on virus populations are initially assessed in HIV-positive adults. Dosing is further refined in studies in HIV-negative adults and infants. This information is used to design an efficacy study in HIV-exposed infants as an adjunct to standard ARV treatment and prophylaxis.</p

Turnaround time (TAT) for the stages in the EID cascade calculated from linear mixed models.

<p>Turnaround time (TAT) for the stages in the EID cascade calculated from linear mixed models.</p

While 77% of women in sub-Saharan Africa have at least one antenatal care (ANC) visit, most are not seen until the second or third trimester [34].

<p>In contrast, the majority of women in the United States access antenatal care during the first trimester <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001616#pmed.1001616-Centers3" target="_blank">[35]</a>.</p