Nyirenda Nyang'Wa, Maggie;
(2023)
Evaluation of Diagnostic Tests for HIV Detection in Children in Malawi.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Annually >40,000 Malawian babies are exposed to HIV, and >1800 get infected. Maternal antibodies limit the utility of HIV antibody testing in children <18 months, and HIV-DNA-PCR is preferred. However, HIV-PCR testing sites are few, PCR is expensive and PCR result turn-around-times (TAT) average 3 months leading to ~ 1/3rd of tested infants being lost to follow-up. A point-of-care HIV Test (POCT) may improve testing uptake and infant retention. This study aimed to identify an appropriate POCT for HIV diagnosis in children <18 months of age and to estimate its impact on infant diagnosis and linkage to HIV care. We conducted mixed methods study in two hospitals in Southern Malawi and evaluated: (1) performance, TAT, usability, acceptability, cost and cost-effectiveness for XpertHIV and compared it with HIV-DNA-PCR, and (2) performance and accuracy of plasma IP-10 in screening for HIV diagnosis and treatment failure among children aged 0-14 years; and (3) explored the potential role of HIV-LAMP assay in the diagnosis of HIV. XpertHIV had high sensitivity (97.8%) and specificity (98.1%). TAT was reduced from 24 days to 5.3 hours: 85% of the children-initiated ART on the day of testing. Compared with qPCR cost ($66.66), XpertHIV was cheaper at $42.34 per diagnostic test. With the difference in test costs, if XpertHIV is adopted nationwide for testing of 40,000 HIV exposed babies, Malawi could save ~USD2,193,538.88 annually. XpertHIV was acceptable to care givers, parents, laboratory technologists and nurses. Although IP-10 levels were higher in those with high viral load and under two years of age, it could not distinguish HIV from other infections. The HIV LAMP optimisation was unsuccessful. XpertHIV, if deployed in Malawi, could improve the diagnosis of paediatric HIV and its treatment uptake, and reduce costs of early infant diagnosis (EID). IP-10 is not an accurate screening marker for HIV in children. Further studies are needed to evaluate whether HIV LAMP is a suitable test for EID
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Evaluation of Diagnostic Tests for HIV Detection in Children in Malawi |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | HIV, infants, children, diagnosis, testing |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10166740 |
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