Wednesday, October 31, 2012

Saving lives in Cambodia through early infant diagnosis of HIV

Two year old girl and her mother in the playroom.
© UNICEF Cambodia/2012/Julie Masis
Van Kunthea*, who is 2 years old, is HIV positive. A few years ago, many HIV positive children like Kunthea didn’t live to see their second birthday. Fortunately, Kunthea was diagnosed within the first six weeks of being born and ever since she has been taking anti-retroviral drugs which prevent the HIV virus from destroying her immune system. Kunthea is healthy and has no symptoms of HIV, and her mother Sao Rasy*, takes her to Battambang Referral Hospital every month for a check-up and a supply of medication.

Kunthea is one of about 375 children with HIV who are receiving antiretroviral treatment free of charge at the hospital in Battamabang province, seven hours away from Cambodia’s capital, Phnom Penh. With UNICEF support, the hospital ensures that babies born to HIV positive mothers are tested for the disease immediately after birth so that those who need it receive life-saving treatment as early as possible.

Dry Blood Spot testing

The test involves obtaining a spot of blood from the newborn’s heel and applying it to specially manufactured absorbent filter paper. After being air-dried it is sent to the laboratory where an early infant diagnostic test - also known as a Polymerase Chain Reaction (PCR) test – can detect the DNA or genetic material of HIV.
The test has several major benefits: samples do not require refrigeration, the test is not invasive, and it does not produce a false positive result. With the HIV antibody test that was administered at 18 months, some babies could test positive - not because they had HIV - but because they still retained some of their mothers’ HIV antibodies (received via the umbilical cord).

This test has saved many lives, says Doctor Chea Pov, who is in charge of the paediatric ward at the hospital. “Before 2008, the HIV test that could be given at 6 weeks of life was very expensive.  We didn’t have the money to pay for it, so we had to use the [HIV rapid antibody] test at 18 months which was cheap,” he said. “[But] by then, most of the HIV positive children had died, or they had become really sick as the disease spread.”

A 2004 Lancet study showed that without life-saving drugs, 30 per cent of HIV positive children die before they turn 1, while 50 per cent do not live to see their second birthday. In view of this, early diagnosis of infants’ HIV status is critical to their survival. 

Dr. Pov explains that before the introduction of the early infant diagnosis HIV test, the Battambang Referral Hospital had to guess babies’ HIV status based on their symptoms. “If we saw the children of HIV positive parents become sick, we would give them the [antiretroviral] medicine, but we were not sure if they were positive or negative,” he explained. “But if I hadn’t given them the medicine to treat HIV, they would have died. I could not wait for 18 months to get the test result.”

This presumptive diagnostic type of approach, however, meant that most HIV positive children did not get medication until they became very sick, while some children without the disease might have been treated for HIV even though they didn’t have it.

No more guessing

Guessing a child’s HIV status is now a thing of the past in Cambodia. HIV-infected infants are being identified and treated earlier, and getting timely access to life-saving paediatric care and antiretroviral treatment services. With funding from the French Committee for UNICEF, early infant diagnostic testing is available at 33 paediatric HIV care sites countrywide. The French Committee also supports the supply of DNA/PCR testing materials, training and refresher-training for paediatric staff and lab technicians on how to collect Dry Blood Spots (DBS) from HIV-exposed infants; database training to monitor HIV-exposed infants; and transportation and food for parents and caregivers to encourage them to bring HIV exposed infants for PCR testing and medical follow-ups.

The French Committee for UNICEF also supported the establishment of a private-public sector partnership using the services of a national courier company to expedite the delivery of blood samples from rural areas to the National Institute Public Health Laboratory in Phnom Penh for analysis. The sooner results can be sent to paediatric care sites, the sooner HIV-infected infants can start their antiretroviral treatment.

The colourful playroom with toys and picture books makes the Battambang Hospital an inviting place for children who go there for checkups. Kunthea’s mother says, “After delivery, I found out that she is HIV positive I felt really sorry for her and was very worried.” Knowing that her daughter is now healthy, her visits to the hospital bring reassurance, “I’m very happy when I see the children playing together. When I come here, I see other people in the same situation, and it makes me feel better.”

By Julie Masis & Denise Shepherd-Johnson

*Names changed to protect identities.

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