Nigeria has one of the highest HIV burdens as well

Nigeria has one of the highest HIV burdens as well Grosvenorine as mother-to-infant transmission rates in the Grosvenorine world. specimens were also tested using Genscreen enzyme-linked immunosorbent assay (EIA) (Bio-Rad France). The turnaround time (TAT) from sample collection Rabbit Polyclonal to GPR52. testing and dispatching of results from each health facility was monitored. A total of 1 1 273 infants with a median age of 12.6 weeks (1 day to 71.6 weeks) participated in the program and 280 (22.0%) were PCR positive. Grosvenorine HIV transmission levels varied greatly in the different health facilities ranging from 7.1% to 38.4%. Infants aged 48 to 72 weeks had the highest level of PCR positivity (41.1%). All PCR-positive specimens were confirmed by retesting. The mean turnaround time from DBS collection to returning of the laboratory result to the health facilities was 25 days. Three infants were found to be HIV antibody negative by rapid tests but were positive by both PCR and the fourth generation EIA. The DBS-based PCR program accurately identified all of the HIV-infected infants. However many programmatic challenges related to the laboratory and TAT were identified. Introduction Nigeria has a high HIV prevalence (4.1%) and 3.3 million infected individuals; in 2010 2010 it was estimated to account for 30% of the global burden of mother-to-child transmission of HIV.1 A continuum of programs including prevention of mother-to-child transmission (PMTCT) early infant diagnosis (EID) and timely referral of infected infants to care is critical to reduce infant morbidity and mortality.2 Nigeria has intensified its efforts to reduce new HIV infections in Grosvenorine children younger than 15 years.3 In 2004 only 431 out of 1 1 688 pregnant women from 11 PMTCT pilot sites accessed primarily single-dose nevirapine antiretroviral therapy (ART).4 By the end of 2013 53 626 HIV-infected pregnant women across the country received effective triple ART (personal communication). Identification of HIV-infected infants by serology before 18 months of age is difficult. This is because of the presence of maternal antibodies5 6 that are acquired transplacentally and can persist for as long as 18 months. Definitive diagnosis requires testing viral nucleic acid or antigen which is technically complex.7-10 Fourth generation antigen-detecting HIV rapid assays are available but their performance is poor.11 Polymerase chain reaction (PCR) to detect viral nucleic acid is commercially available and has been adopted in resource-poor settings and is recommended by the World Health Organization (WHO) to diagnose HIV-infected infants. In 2006 the Nigerian Institute of Medical Research (NIMR) was using a quantitative plasma RNA viral load assay to detect Grosvenorine HIV-infected infants on a small scale.12 To establish a larger-scale EID service the Nigerian Federal Ministry of Health (FMOH) with the assistance of the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Agency for International Development (USAID) with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) conducted a demonstration project in 2007 in Lagos using dried blood spots (DBS) and a DNA PCR assay.13 Here we report the prevalence of HIV transmission in participating hospitals and the challenges encountered. Materials and Methods Study population Infants enrolled in this study were aged less than 18 months and were either (1) known HIV-exposed infants referred from the PMTCT program or other settings in the facility or (2) sick infants whose HIV status was not necessarily known but who presented with signs and/or symptoms suggestive of HIV.14 Some major signs and symptoms include growth failure failure to thrive wasting failure to attain typical milestones and recurrent bacterial fungal or viral infections. Ethical approval and informed consent All testing followed approval from the National Health Research Ethics Committee Nigeria and the U.S. CDC Institutional Review Board in Atlanta Georgia. Parents/guardians of infected children provided written informed consent for study participation. Consent allowed for storage and future analysis of stored specimens. Study participant description Infants (= 1 273 younger than 18 months of age attending PMTCT and pediatric facilities in six mother-and-child health (MCH) facilities in Lagos between February 2007 and October 2008 were recruited. The hospitals were Grosvenorine Isolo General Hospital (IGH) Lagos State University Teaching Hospital.