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）：婴儿早期诊断 (EID) 的主要目标是在出现临床疾病之前识别 HIV+ 婴儿，以促进早期开始 ART 并提高婴儿存活率。每年，艾滋病毒阳性母亲所生的肯尼亚婴儿中，有近 20% 受到感染（约 20,000 名）。如果没有早期诊断和抗逆转录病毒治疗，这些艾滋病毒+婴儿中一半以上将在两岁时死亡；然而，早期开始抗逆转录病毒治疗 (ART)（12 周前）可将死亡风险降低 76%。 2008 年，肯尼亚国家政策进行了修订，包括通过 PCR 检测对所有确诊为 HIV+ 的婴儿快速启动儿科 ART。然而，目前的 EID 系统受到重大结构性障碍的阻碍，这些障碍导致对 HIV 暴露婴儿的延迟和零星检测、丢失或延迟检测结果来自实验室，并且缺乏可靠的系统来通知母亲检测结果或需要返回医院。因此，只有大约三分之一的 HIV 暴露婴儿会接受 EID 护理直至 18 个月大。拟议的研究将评估 HIV 婴儿追踪系统 (HITSystem(c)) 的影响和成本效益，这是一种带有自动警报的在线干预措施，旨在通过前瞻性追踪 HIV 暴露婴儿、改善 PCR 的沟通来克服当前的 EID 障碍。将实验室的结果传递给诊所和母亲，并支持现有网络以促进高质量的艾滋病毒儿科护理。这种强大的干预措施使临床医生、实验室技术人员和项目经理能够通过在线条目“实时”跟踪 EID 和 ART 项目的时间敏感干预措施，当特定婴儿的时间敏感干预措施过期时，会触发行动“警报”。当测试结果准备好或需要后续访问时，内置短信系统会自动向母亲的手机发送短信。 HITSystem 的最终目标是增加 EID 服务中保留的 HIV 暴露婴儿数量（直至 18 个月），并促进诊断为 HIV + 的婴儿早期开始 ART。比较肯尼亚两家资源匮乏医院的 HITSystem 干预前 (n=330) 和干预后 (n=460) 数据的有希望的试点数据表明，实施该系统的可接受性和可行性，从而显着提高了 EID 保留率（干预前 31%，干预后 31%）。 97% 后），以及诊断为 HIV+ 的婴儿的 ART 启动率（前 44%，后 95%）。