Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time

Figures & data

Figure 1. Flow chart for early infant diagnosis cascade among HIV-exposed babies eligible for PCR test (age <9 months at enrolment) under integrated HIV care program, Myanmar, 2013–2015.

Note: HIV: human immunodeficiency virus; PCR: Polymerase chain reaction test used for early infant diagnosis of HIV; ART: anti-retroviral therapy.

Table 1. Socio-demographic characteristics of HIV-exposed babies eligible for a PCR test (age <9 months at enrolment) under the integrated HIV care program, Myanmar, 2013–2015.

Characteristics		n	%
Total		1349	100
Sex of baby
	Male	655	49
	Female	637	47
	Not recorded	57	4
Age of mother at enrolment
in years	<18	3	<1
	18–24	218	16
	25–34	600	44
	≥35	169	13
	Not recorded	359	27
Mother’s marital status
	Single mother	10	1
	Married	727	54
	Widow	40	3
	Divorced/separated	13	1
	Not recorded	559	41
Mother’s education status
	Literate	702	52
	Not literate	239	18
	Not recorded	408	30
Mother’s employment status
	Employed	308	23
	Unemployed/homemaker	461	34
	Not recorded	580	43

HIV: human immunodeficiency virus; PCR: Polymerase chain reaction test used for early infant diagnosis of HIV.

Table 2. Clinical and programmatic characteristics of HIV-exposed babies eligible for a PCR test (age <9 months at enrolment) under integrated HIV care program, Myanmar, 2013–2015.

Characteristics		n	%
Total		1349	100
Mother’s baseline CD4
cells/mm^3	<100	102	8
	100–349	403	30
	≥350	404	30
	Not recorded	440	32
Mother’s pre-delivery
treatment status	On ART before pregnancy	525	39
	On PMTCT	281	21
	Not on ART and PMTCT	543	40
Mode of delivery
	NSVD	449	33
	AVD	3	<1
	LSCS	795	59
	Not recorded	102	8
Place of delivery
	Hospital	1111	82
	Private	3	<1
	Home	135	10
	Not recorded	100	8
Programmatic factors		N	Median (IQR)
Distance of ART center from patient’s township in kilometers		1349	11 (3,49)
Distance of PCR facility from patient’s ART center in kilometers		1349	128 (3, 279)

Note: HIV: human immunodeficiency virus; PCR: Polymerase chain reaction test used for early infant diagnosis of HIV; ART: anti-retroviral therapy; PMTCT: prevention of mother to child transmission; NSVD: normal spontaneous vaginal delivery; AVD: assisted vaginal delivery; LSCS: lower section caesarian section; IQR: Inter quartile range.

Figure 2. Cumulative proportion of sample collected at different ages among HIV-exposed babies eligible for PCR test (age <9 months at enrolment) under integrated HIV care program, Myanmar, 2013–2015 (N = 1256)*.

Note: Number at risk in the figure indicates those who are eligible for PCR and not tested at the given time*1-Kaplan Meier curve; 93 HIV-exposed babies who belonged to the patient population (age <9 months at enrolment) but were excluded from this analysis due to non-availability of dates.

Table 3. Median age at enrolment /blood collection and turnaround time in EID cascade among HIV-exposed babies eligible for PCR test (age <9 months at enrolment) under integrated HIV care program, Myanmar, 2013–2015.

Age /time in weeks	n*	Median	IQR
Median age at enrollment	1349	1.4	0.0, 7.0
Median age at blood collection	1000	6.7	6.0, 10.7
Turnaround time to mother receiving result from blood collection	677	7.0	4.0, 12.0
Turnaround time to start ART from result receipt by mother (among HIV-infected)	42	8.5	5.8, 15.9

*Includes patients who were available and respective dates were recorded.

Note: EID: Early infant diagnosis; HIV: human immunodeficiency virus; PCR: Polymerase chain reaction test used for early infant diagnosis of HIV; ART: anti-retroviral therapy; IQR: Inter quartile range.

Table 4. Factors associated with delayed (≥8 weeks of age) or no blood sample collection among HIV-exposed babies eligible for PCR test (age <9 months at enrolment) under integrated HIV care program, Myanmar, 2013–2015.

Variable	Type	Evaluated ** (n)	Delay/not collected n (%)	RR (95%CI)	aRR (95%CI)**
Total		1349	716 (53)	–	–
Socio-demographic
Sex of baby	Female	637	331(52)	1.0(0.9,1.1)	1.0(0.8,1.1)
	Male	655	328(50)	Ref.	Ref.
Age of mother in years	<18	3	0(0)	–	–
	18–24	218	107(49)	1.1(0.8,1.3)	1.0(0.8,1.3)
	25–34	600	266(44)	1.0(0.8,1.2)	0.9(0.8,1.2)
	≥35	169	75(44)	Ref.	Ref.
Mother’s marital status	Single mother	10	4(40)	1.0(0.4,2.3)	–
	Married	727	275(38)	Ref.	–
	Widow	40	11(28)	0.7(0.4,1.2)	–
	Divorced/separated	13	7(54)	1.4(0.9,2.4)	–
Mother’s education status	Literate	702	255(36)	Ref.	–
	Not literate	239	175(73)	2.0(1.8,2.3)*	–
Mother employed	Yes	308	99(32)	Ref.	–
	No/Homemaker	461	190(41)	1.3(1.0,1.6)*	–
Clinical factors
Mother’s baseline	<100	102	46(45)	1.2(0.9,1.5)	–
CD4 cells/mm^3	100–349	403	155(39)	1.0(0.8,1.2)	–
	≥350	404	161(40)	Ref	–
Mother’s pre-	On ART	281	121(43)	Ref.	Ref.
delivery treatment	On PMTCT	525	161(31)	1.4(1.2,1.7)*	1.4(1.1,1.8)*
status	None	543	434 (80)	2.6(2.3,3.0)*	1.8(1.5,2.2)*
Mode of delivery	NSVD	449	275(61)	1.4(1.3,1.6)*	1.1(1.0,1.3)
	AVD	3	2(67)	–	–
	LSCS	35	23(66)	Ref	Ref
Place of delivery	Hospital	1111	533(48)	Ref.	Ref.
	Private	3	1(33)	–	–
	Home	135	94(70)	1.5(1.3,1.7)*	1.2(0.9,1.4)
Programmatic factors
Distance from ART	≥11 km	719	424(59)	1.3(1.2,1.4)*	1.0(0.9,1.2)
center to patient residence	<11 km	630	292(46)	Ref.	Ref.
Distance from ART	≥128 km	700	517(74)	2.4(2.1,2.7)*	2.2(1.8,2.7)*
center to laboratory	<128 km	649	199(31)	Ref.	Ref.

*statistically significant, p < 0.05; ** Adjusted RR, complete case analysis (415 cases excluded), using poisson regression (enter method); factors with unadjusted p < 0.2 were included in model; mother employment/literacy status, were excluded due to high collinearity.

Note: HIV: human immunodeficiency virus; EID: early infant diagnosis; ART: anti-retroviral therapy; PMTCT: prevention of mother to child transmission; NSVD: normal spontaneous vaginal delivery; AVD: assisted vaginal delivery; LSCS: lower section caesarian section; km: kilometer; RR: Relative risk.