Early infant diagnosis is important for timely identification of HIV-infected infants and linkage to care. Testing at birth has been implemented to facilitate earlier diagnosis of HIV infection but may present new challenges. This study was conducted to understand the acceptability and feasibility of birth testing in urban and rural settings in southern Zambia. This cross-sectional study was conducted at 11 hospitals and clinics in Livingstone, Choma, and Macha in Southern Province, Zambia from 2016 to 2018. Infants born to pregnant women living with HIV at the sites were eligible for enrollment. After enrollment, a questionnaire was administered to the mother and a dried blood spot card was collected from infants for testing at a central laboratory. When results were available, mothers were notified to return to the clinic. Acceptability of birth testing was evaluated based on the proportion of women who agreed to participate and the reasons for non-participation among women who declined. Feasibility of testing at birth was evaluated using turnaround times for returning results, the proportion of women receiving results, and linkage to care for infants testing positive. One thousand four hundred three women were approached for the study. A small proportion declined due to refusal of birth testing (0 to 8.2% across sites). One thousand two hundred ninety women agreed to have their infants tested. The proportion of mothers receiving results ranged from 51.6 to 92.1%, and was significantly lower at the hospital than clinics in Livingstone (51.6% vs. 69.8%; p < 0.0001) and Macha (69.5% vs. 85.7%; p < 0.0001) but not Choma (85.7% vs. 92.1%; p = 0.34). For mothers who received test results, the median turnaround time from sample collection was 67 days in Livingstone and 53 days in Macha and Choma. Overall, 23 (1.8%) infants tested positive for HIV but only 8 (34.8%) were linked to care a median of 68 days (range: 29, 784) after sample collection. While testing at birth was acceptable, this study highlights the operational challenges under a centralized laboratory testing system. Point-of-care platforms are needed for rapid testing and return of results so HIV-infected children can be identified, linked to care, and treated as early as possible.

中文翻译：

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赞比亚农村和城市出生时艾滋病毒感染检测及其与护理的联系的可接受性和可行性：一项横断面研究。


婴儿早期诊断对于及时识别艾滋病毒感染婴儿并与护理联系起来非常重要。出生时检测已实施，以促进艾滋病毒感染的早期诊断，但可能会带来新的挑战。进行这项研究的目的是了解赞比亚南部城市和农村地区出生检测的可接受性和可行性。这项横断面研究于 2016 年至 2018 年在赞比亚南部省利文斯顿、乔马和马查的 11 家医院和诊所进行。这些地点感染艾滋病毒的孕妇所生的婴儿符合纳入资格。登记后，对母亲进行了问卷调查，并从婴儿身上收集了一张干燥的血斑卡，以便在中心实验室进行检测。当结果出来时，母亲们被通知返回诊所。根据同意参加的妇女比例以及拒绝参加的妇女不参加的原因来评估出生测试的可接受性。使用返回结果的周转时间、收到结果的女性比例以及与检测呈阳性的婴儿护理的联系来评估出生时检测的可行性。这项研究接触了一千四百三名女性。一小部分人由于拒绝出生测试而下降（各站点的比例为 0% 至 8.2%）。一千二百九十名妇女同意对她们的婴儿进行检查。收到结果的母亲比例为 51.6% 至 92.1%，在医院显着低于利文斯顿 (51.6% vs. 69.8%；p < 0.0001) 和马查 (69.5% vs. 85.7%；p <) 的诊所0.0001），但乔马则不然（85.7% vs. 92.1%；p = 0.34）。 对于收到检测结果的母亲来说，利文斯顿从样本采集开始的中位周转时间为 67 天，马查和乔马为 53 天。总体而言，23 名婴儿 (1.8%) 的 HIV 检测呈阳性，但只有 8 名婴儿 (34.8%) 在样本采集后接受了中位数 68 天的护理（范围：29, 784 天）。虽然出生时检测是可以接受的，但这项研究强调了集中实验室检测系统下的操作挑战。需要即时检测平台来进行快速检测和返回结果，以便能够尽早识别艾滋病毒感染儿童、将其与护理联系起来并进行治疗。