Implementation and Uptake of Raltegravir Granules in Newborns Diagnosed With HIV Through Birth Testing in Maternity Settings in Zimbabwe During the COVID-19 Pandemic

Denoeud-Ndam, Lise; Stecker, Carl; Andifasi, Precious; Mushavi, Angela; Maphosa, Talent; Zondo, Mongiwa; Murandu, Mildrate; Gombakomba, Gladys; Katirayi, Leila; Mungati, More; Bailey, Rebecca; Weber, Rachel P.; Rivadeneira, Emilia D; Hrapcak, Susan

doi:10.1097/INF.0000000000003906

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Implementation and Uptake of Raltegravir Granules in Newborns Diagnosed With HIV Through Birth Testing in Maternity Settings in Zimbabwe During the COVID-19 Pandemic

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Author(s): Lise Denoeud-Ndam , MD, PhD ^* ^, , Carl Stecker , MPH, EdD ^† , Precious Andifasi , MD ^‡ , Angela Mushavi , MD ^‡ , Talent Maphosa , MDS ^§ , Mongiwa Zondo , MSc ^¶ , Mildrate Murandu , Msc ^¶ , Gladys Gombakomba , MD ^¶ , Leila Katirayi , PhD ^‖ , More Mungati , MD ^¶ , Rebecca Bailey , MSPH ^* , Rachel Weber , PhD ^§ , Emilia Rivadeneira , MD ^** , Susan Hrapcak , MD ^**

Publication date (Electronic): 20 March 2023

Journal: The Pediatric Infectious Disease Journal

Publisher: Lippincott Williams & Wilkins

Keywords: raltegravir, neonatal, Zimbabwe, HIV

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Abstract

Zimbabwe introduced raltegravir (RAL) granules at 14 facilities providing point-of-care HIV birth testing, aiming to initiate all newborns with HIV on a RAL-based regimen. From June 2020 to July 2021, we tested 3172 of the 6989 (45%) newborns exposed to HIV; we diagnosed 59(2%) with HIV infection, of whom 27 (46%) initiated RAL. The SARS-CoV-2 coronavirus disease pandemic exacerbated supply chain and trained provider shortages, contributing to low birth testing, RAL uptake and 6-month viral load testing.

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Impact of Routine Point-of-Care Versus Laboratory Testing for Early Infant Diagnosis of HIV: Results From a Multicountry Stepped-Wedge Cluster-Randomized Controlled Trial

Emma Sacks, Jennifer Cohn, Bernard Ochuka … (2020)

Supplemental Digital Content is Available in the Text.

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Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study

Catherine Wexler, May Maloba, Melinda K. Brown … (2019)

Background At-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya. Methods We conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources. Results Most providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before–possibly–learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier. Discussion While overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.

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Acceptability and Feasibility of Using Raltegravir Oral Granules for the Treatment of Neonates in a Low-resource Setting.

Moherndran Archary, Brian C. Zanoni, Marc Lallemant … (2020)

Raltegravir granules for oral suspension, now recommended by World Health Organization for use in neonates with HIV infection, may be challenging for caregivers because of the multistep preparation required.

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Author and article information

Contributors

Carl Stecker

Precious Andifasi

Angela Mushavi

Talent Maphosa

Mongiwa Zondo

Mildrate Murandu

Gladys Gombakomba

Leila Katirayi

More Mungati

Rebecca Bailey

Rachel Weber

Emilia Rivadeneira

Susan Hrapcak

Journal

Journal ID (nlm-ta): Pediatr Infect Dis J

Journal ID (iso-abbrev): Pediatr Infect Dis J

Journal ID (publisher-id): INF

Title: The Pediatric Infectious Disease Journal

Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )

ISSN (Print): 0891-3668

ISSN (Electronic): 1532-0987

Publication date (Electronic): 20 March 2023

Publication date (Print): July 2023

Publication date PMC-release: 20 March 2023

Volume: 42

Issue: 7

Pages: 573-575

Affiliations

From the [* ]Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland

[† ]Catholic Relief Services, Baltimore, Maryland

[‡ ]Ministry of Health and Child Care, Harare, Zimbabwe

[§ ]Division of Global HIV and TB, Centers for Disease Control and Prevention, Harare, Zimbabwe

[¶ ]Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe

[‖ ]Elizabeth Glaser Pediatric AIDS Foundation, Washington DC

[** ]Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia.

Author notes

Address for correspondence: Lise Denoeud-Ndam, MD, PhD, Elizabeth Glaser Pediatric AIDS Foundation, 150 Route de Ferney, P.O. Box 2100, CH-1211 Geneva 2, Switzerland. E-mail: ldenoeud@ 123456pedaids.org .

Author information

Lise Denoeud-Ndam https://orcid.org/0000-0002-9482-1461

Article

Accession ID: 00008

DOI: 10.1097/INF.0000000000003906

PMC ID: 10289070

PubMed ID: 37000925

SO-VID: bf95d07a-9767-4c90-8a85-fcc0c75e232d

License:

This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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Date accepted : 24 February 2023

Implementation and Uptake of Raltegravir Granules in Newborns Diagnosed With HIV Through Birth Testing in Maternity Settings in Zimbabwe During the COVID-19 Pandemic

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Novel Coronavirus Disease COVID-19

Most cited references 11

Impact of Routine Point-of-Care Versus Laboratory Testing for Early Infant Diagnosis of HIV: Results From a Multicountry Stepped-Wedge Cluster-Randomized Controlled Trial

Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study

Acceptability and Feasibility of Using Raltegravir Oral Granules for the Treatment of Neonates in a Low-resource Setting.

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