Integrated point-of-care testing (POCT) of HIV, syphilis, malaria and anaemia in antenatal clinics in western Kenya: A longitudinal implementation study.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Dietary Supplements*; Anemia/*diagnosis ; HIV Infections/*diagnosis ; Malaria/*diagnosis ; Pregnancy Complications, Hematologic/*prevention & control ; Pregnancy Complications, Infectious/*prevention & control ; Syphilis/*diagnosis; Adult ; Anemia/drug therapy ; Anemia/metabolism ; Anti-Bacterial Agents/therapeutic use ; Anti-HIV Agents/therapeutic use ; Antimalarials/therapeutic use ; Artemether, Lumefantrine Drug Combination/therapeutic use ; Artemisinins/therapeutic use ; Erythromycin/therapeutic use ; Female ; Folic Acid/administration & dosage ; Guideline Adherence ; HIV Infections/drug therapy ; HIV Infections/metabolism ; Health Personnel ; Humans ; Iron, Dietary/administration & dosage ; Kenya ; Laboratory Proficiency Testing/statistics & numerical data ; Longitudinal Studies ; Malaria/drug therapy ; Malaria/metabolism ; Penicillins/therapeutic use ; Point-of-Care Testing/statistics & numerical data ; Pregnancy ; Pregnancy Complications, Hematologic/diagnosis ; Pregnancy Complications, Hematologic/metabolism ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/metabolism ; Prenatal Care/statistics & numerical data ; Quinine/therapeutic use ; Quinolines/therapeutic use ; Syphilis/drug therapy ; Syphilis/metabolism ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
    • Abstract:
      Background: In sub-Saharan Africa, HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes. In Kenya, policy states women should be tested for all four conditions (malaria only if febrile) at first antenatal care (ANC) visit. In practice, while HIV screening is conducted, coverage of screening for the others is suboptimal and early pregnancy management of illnesses is compromised. This is particularly evident at rural dispensaries that lack laboratories and have parallel programmes for HIV, reproductive health and malaria, resulting in fractured and inadequate care for women.
      Methods: A longitudinal eight-month implementation study integrating point-of-care diagnostic tests for the four conditions into routine ANC was conducted in seven purposively selected dispensaries in western Kenya. Testing proficiency of healthcare workers was observed at initial training and at three monthly intervals thereafter. Adoption of testing was compared using ANC register data 8.5 months before and eight months during the intervention. Fidelity to clinical management guidelines was determined by client exit interviews with success defined as ≥90% adherence.
      Findings: For first ANC visits at baseline (n = 529), testing rates were unavailable for malaria, low for syphilis (4.3%) and anaemia (27.8%), and near universal for HIV (99%). During intervention, over 95% of first attendees (n = 586) completed four tests and of those tested positive, 70.6% received penicillin or erythromycin for syphilis, 65.5% and 48.3% received cotrimoxazole and antiretrovirals respectively for HIV, and 76.4% received artemether/lumefantrine, quinine or dihydroartemisinin-piperaquine correctly for malaria. Iron and folic supplements were given to nearly 90% of women but often at incorrect doses.
      Conclusions: Integrating point-of-care testing into ANC at dispensaries with established HIV testing programmes resulted in a significant increase in testing rates, without disturbing HIV testing rates. While more cases were detected and treated, treatment fidelity still requires strengthening and an integrated monitoring and evaluation system needs to be established.
      Competing Interests: The authors have declared that no competing interests exist.
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    • Molecular Sequence:
      Dryad 10.5061/dryad.7k620
    • Accession Number:
      0 (Anti-Bacterial Agents)
      0 (Anti-HIV Agents)
      0 (Antimalarials)
      0 (Artemether, Lumefantrine Drug Combination)
      0 (Artemisinins)
      0 (Iron, Dietary)
      0 (Penicillins)
      0 (Quinolines)
      63937KV33D (Erythromycin)
      6A9O50735X (artenimol)
      8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination)
      935E97BOY8 (Folic Acid)
      A0HV2Q956Y (piperaquine)
      A7V27PHC7A (Quinine)
    • Publication Date:
      Date Created: 20180721 Date Completed: 20181226 Latest Revision: 20210915
    • Publication Date:
      20221213
    • Accession Number:
      PMC6054376
    • Accession Number:
      10.1371/journal.pone.0198784
    • Accession Number:
      30028852