Evaluation of the HITSystem to Improve Early Infant Diagnosis Outcomes in Kenya

对改善肯尼亚婴儿早期诊断结果的 HIT 系统进行评估

基本信息

批准号：
8843505
负责人：
SARAH Finocchario KESSLER
金额：
$ 49.43万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-15 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8843505
关键词：
Accountability Acquired Immunodeficiency Syndrome Address Africa South of the Sahara Age Age-Months Antibodies Benchmarking Caring Cellular Phone Cessation of life Child Childhood Clinic Clinical Collaborations Communication Cost Effectiveness Analysis Cotrimoxazole Counseling Country DNA Data Development Diagnosis Diagnostic Services Disease Early Diagnosis Early Intervention Electronics Enrollment Evaluation Family Goals Government Guidelines HIV HIV Infections HIV diagnosis Health Hospitals Human immunodeficiency virus test Infant Infant Care Intervention Kenya Laboratories Life Medical Research Mothers Outcome Pneumocystis carinii Pneumonia Policies Prophylactic treatment Provider Public Health Randomized Controlled Trials Research Institute Resources Respiratory Tract Infections Risk Schedule Site Specific qualifier value System Technology Test Result Testing Text Time Vertical Disease Transmission Visit antiretroviral therapy arm cost effectiveness design diagnosis quality feeding follow-up hospital laboratories improved interest mortality pediatric human immunodeficiency virus post intervention prevent programs prospective satisfaction scale up service utilization standard of care therapy design

项目摘要

DESCRIPTION (provided by applicant): The primary goal of early infant diagnosis (EID) is to identify HIV+ infants prior to the development of clinical disease to facilitate early initiation o ART and improve infant survival. Nearly 20% of Kenyan infants born to HIV+ mothers each year become infected (roughly 20,000). Without early diagnosis and ART over half of these HIV+ infants will die by the age of two years; however, early antiretroviral therapy (ART) initiation (before 12 weeks) can reduce the risk of mortality by 76%. In 2008 Kenyan National Policy was revised to include rapid initiation of pediatric ART to all infants confirmed HIV+ with PCR testing The current EID system, however, is hampered by significant structural barriers that contribute to late and sporadic testing of HIV exposed infants, lost or delayed test results from the laboratory, and the absence of a reliable system to notify mothers of test results or the need to return to the hospital. Consequently, only about one-third of HIV-exposed infants are retained in EID care until 18 months of age. The proposed study will evaluate the impact and cost-effectiveness of the HIV Infant Tracking System (HITSystem(c)), an online, intervention with automated alerts designed to overcome current EID barriers by prospectively tracking HIV-exposed infants, improving the communication of PCR results from laboratories to both clinics and mothers, and supporting existing networks to facilitate quality HIV pediatric care. This robust intervention allows clinicians, lab technicians, and program managers to track the time sensitive interventions of EID and ART programs in "real-time" through online entries which trigger action 'alerts' when time sensitive interventions are overdue for specific infants. A builtin text messaging system sends automated text messages to mothers' cell phones when test results are ready or follow up visits are needed. The ultimate goals of the HITSystem are to increase the number of HIV-exposed infants retained in EID services (until 18 months), and facilitate early ART initiation for infants diagnosed HIV+. Promising pilot data comparing pre (n=330) and post (n=460) HITSystem intervention data at two low resource hospitals in Kenya demonstrate acceptability and feasibility of implementing the system which led to highly significant improvements in EID retention (31% pre vs. 97% post), and ART initiation rates for infants diagnosed HIV+ (44% pre vs. 95% post).

描述（由申请人提供）：早期婴儿诊断（EID）的主要目标是在临床疾病发展之前识别HIV+婴儿，以促进早期起步O ART并改善婴儿的生存率。每年艾滋病毒+母亲出生的肯尼亚婴儿中有将近20％被感染（大约20,000）。没有早期诊断和艺术，这些艾滋病毒+婴儿中有一半将死于两岁。但是，早期的抗逆转录病毒疗法（ART）启动（12周之前）可以将死亡率的风险降低76％。在2008年，肯尼亚国家政策对所有确认的艾滋病毒+的儿科艺术进行了修订，并通过PCR测试进行了当前的开斋节系统，这受到了严重的结构性障碍的阻碍，这些结构障碍会导致艾滋病毒暴露于艾滋病毒暴露的婴儿的迟到和零星测试，损失了从实验室中损失或延迟的测试结果，无法进行可靠的测试，无法进行验证或无需检查或无法进行的或无法进行的或无法进行的。因此，直到18个月大，只有大约三分之一的艾滋病毒暴露婴儿保留在开斋节中。 The proposed study will evaluate the impact and cost-effectiveness of the HIV Infant Tracking System (HITSystem(c)), an online, intervention with automated alerts designed to overcome current EID barriers by prospectively tracking HIV-exposed infants, improving the communication of PCR results from laboratories to both clinics and mothers, and supporting existing networks to facilitate quality HIV pediatric care.这种强大的干预措施使临床医生，实验室技术人员和计划经理可以通过在线条目中跟踪“实时”和“实时”中的EID和艺术计划的时间敏感干预措施，这些条目在特定婴儿的时间敏感干预措施过期时触发动作“警报”。当需要测试结果或随访访问时，内置的文本消息系统将自动短信发送给母亲的手机。 HITSYSTEM的最终目标是增加在EID服务中保留的艾滋病毒暴露婴儿的数量（直到18个月），并促进诊断为诊断出HIV+的婴儿的早期艺术启动。在肯尼亚的两家低资源医院的PRE（n = 330）和POST（n = 460）比较PRE（n = 330）和POST（n = 460）的有前途的飞行员数据表明，实施该系统的可接受性和可行性，这导致了EID保留率的显着改善（31％PRE PRE PRE，vs. 97％vs. 97％vs. 97％），以及诊断为HIV的HIV+ Pre+（44％pre）（44％preds）（44％Pre）。