African Journal of Public Health and Health Systems | 20 April 2010
Assessing the Impact of Point-of-Care Early Infant Diagnosis on Mother-to-Child HIV Transmission in Zambia's Copperbelt Province: A 2010 Programme Evaluation
M, u, l, e, n, g, a, M, w, a, n, g, o, ,, C, h, a, n, d, a, B, a, n, d, a, ,, M, w, i, l, a, C, h, i, b, w, e
Abstract
Mother-to-child transmission (MTCT) of HIV remains a significant public health challenge in sub-Saharan Africa. Early infant diagnosis (EID) is critical for timely intervention, but conventional laboratory-based testing often involves lengthy delays, which can increase transmission risk and loss to follow-up. This working paper evaluates the impact of introducing point-of-care (POC) EID technology on MTCT rates within prevention of mother-to-child transmission (PMTCT) programmes in Zambia's Copperbelt Province. The primary objective was to quantify changes in transmission following POC EID implementation. A retrospective programme evaluation was conducted using routine health facility data. The analysis compared MTCT outcomes for infants born to HIV-positive mothers before and after the introduction of POC EID testing at selected sites. Data on infant testing, result turnaround times, and final HIV status were analysed. Analysis indicated a reduction in the MTCT rate following POC EID rollout. The mean turnaround time for EID results decreased from several weeks to under two days. Qualitative notes highlighted improved clinical decision-making and caregiver reassurance due to faster results. The integration of point-of-care EID into PMTCT programmes was associated with a reduction in mother-to-child HIV transmission in this setting. This reduction was likely facilitated by substantially reduced diagnostic delays. Scale-up of POC EID technology to other regions should be considered, accompanied by strengthened health worker training and robust monitoring systems to ensure quality. Further operational research is needed to assess long-term outcomes and cost-effectiveness. HIV, early infant diagnosis, point-of-care testing, mother-to-child transmission, programme evaluation, Zambia, PMTCT This working paper provides evidence from a real-world programme setting to inform policy decisions on implementing point-of-care early infant diagnosis.