student research day - Case Western Reserve University School of ...

Melissa Latigo
The potential impact of infant HIV point-of-care tests in Uganda
Melissa Latigo, Kara Palamountain, Mitra Afshari and Mendel Singer, Ph.D.
Epidemiology and Biostatistics, Center for Innovation in Global Health Technology
Case Western Reserve University, Northwestern University
In Uganda, about 80,000 infants are at risk from contracting HIV annually. Dried blood spot DNA PCR
(sensitivity = 94.35%, specificity = 98%) is the gold standard in infant HIV diagnosis. However, lengthy result
turnaround times decrease the probability that infant caregivers return for results and that infants receive timely
treatment. Northwestern University researchers are designing a portable p24 antigen (Ag) test (sensitivity =
84.92%, specificity = 97.02%) and a bench-top DNA PCR test (sensitivity = 94.35%, specificity = 98%) that can
be used in the clinic setting and turn around results in under 1 hour.
We evaluated whether it is cost-effective to diagnose infant HIV in Uganda using novel point-of-care (POC) tests
versus a laboratory-based test.
The study involved a cost-effectiveness analysis that incorporated the decision model for testing asymptomatic
infants at risk for HIV. The main outcome was the number of true infant HIV cases identified given that a
caregiver returned for results. Probability of caregiver return with a POC test was assumed to be 100%. We
collected the POC and the laboratory-based test costs related to infant HIV diagnosis. Costs were obtained from
the Ministry of Health perspective.
Testing records revealed an estimated infant HIV of prevalence of 18.29% (14,632 HIV-infected infants annually).
The laboratory-based test would identify 7960 (54.4%) infants at $18.70 per test. The p24 Ag and DNA PCR POC
tests would identify 12,432 (84.96%) infants at $3.00 per test and 13,824 (94.48%) infants at $8.80 per test
respectively. The DNA PCR and p24 Ag POC tests on average cost $51.11 and $19.31 respectively per infant HIV
case identified.
POC tests are more cost-effective and would increase the average number of infants identified by about 5000
(65%). At a fixed budget, the p24 Ag POC test would be able to identify more infant HIV cases.
Supported by Crile Fellowship, Sigma Xi Grants-in-Aid of Research, Northwestern University, Case Western Reserve
University Research Showcase.
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