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Objective To see if, in the diagnosis of infant infection with human immunodeficiency virus (HIM) in Zambia, turnaround times could be reduced by using an automated notification system based on mobile phone texting. Methods In Zambia's Southern province, dried samples of blood from infants are sent to regional laboratories to be tested for HIV with polymerase chain reaction (PCR). Turnaround times for the postal notification of the results of such tests to 10 health facilities over 19 months were evaluated by retrospective data collection. These baseline data were used to determine how turnaround times were affected by customized software built to deliver the test results automatically and directly from the processing laboratory to the health facility of sample origin via short message service (SMS) texts. SMS system data were collected over a 7.5-month period for all infant dried blood samples used for HIV testing in the 10 study facilities. Findings Mean turnaround time for result notification to a health facility fell from 44.2 days pre-implementation to 26.7 days post-implementation. The reduction in turnaround time was statistically significant in nine (90%) facilities. The mean time to notification of a caregiver also fell significantly, from 66.8 days pre-implementation to 35.0 days post-implementation. Only 0.5% of the texted reports investigated differed from the corresponding paper reports. Conclusion The texting of the results of infant HIV tests significantly shortened the times between sample collection and results notification to the relevant health facilities and caregivers. Objectif Verifier si l'utilisation d'un systeme automatique de notification base sur l'envoi de SMS permettrait de reduire les delais de depistage du virus de l'immunodeficience humaine (VIH) chez les nourrissons en Zambie. Methodes Dans la province meridionale de la Zambie, les echantillons seches de sang de nourrissons sont envoyes aux laboratoires regionaux pour le test du VlH par reaction en chaine a la polymerase (RCP). Les delais de notification par la poste des resultats de ces tests a 10 centres de sante sur 19 mois ont ete evalues au moyen d'une collecte de donnees retrospectives. Ces donnees de base ont ete utilisees pour determiner comment les delais etaient affectes par I'utilisation d'un logiciel personnalise, concu pour envoyer par SMS les examens de sang automatiquement et directement depuis le laboratoire d'analyse vers le centre de sante d'ou proviennent les echantillons. Les donnees du systeme SMS ont ete collectees sur une periode de 7,5 mois pour tous les echantillons seches de sang de nourrissons pour le depistage du VIH dans les 10 centres de sante. Resultats Le delai moyen pour la notification des resultats a une clinique est passe de 44,2 jours pre-implementation a 26,7 jours post-implementation. La reduction du delai etait significative du point de vue statistique dans 9 centres de sante (90%). Le delai moyen de notification d'un soignant a egalement considerablement diminue, passant de 66,8 jours pre-implementation a 35 jours post-implementation. Seuls 0,5% des rapports analyses envoyes par SMS differaient des rapports papier correspondants. Conclusion L'envoi par SMS des resultats des tests VlH chez les nourrissons a considerablement raccourci les delais entre la collecte des echantillons et la notification des resultats aux centres de sante et aux soignants concernes. Objetivo Observar si se puede reducir el tiempo de diagnostico de la infeccion por el virus de la inmunodeficiencia humana (VIH) en lactantes en Zambia mediante un sistema de notificacion automatica a traves de mensajes de texto a telefonos moviles. Metodos Se enviaron muestras de sangre seca de lactantes procedentes de la provincia meridional de Zambia a laboratorios regionales para realizar la prueba del VIH con la reaccion en cadena de la polimerasa (PRC). A traves de una recopilacion de datos retrospectivos se evaluaron los plazos de notificacion postal de los resultados de dichas pruebas a 10 centros sanitarios durante mas de 19 meses. Esos datos de referencia se emplearon para determinar como podian verse afectados los plazos por la aplicacion de un software adaptado que transmitiera los resultados de las pruebas de forma automatica y directa desde el laboratorio de procesado al centro sanitario origen de las muestras mediante un servicio de mensajeria de texto (SMS). Durante un periodo de 7 meses y medio se recopilaron los datos del sistema de SMS para todas las muestras de sangre desecada a las que se realizo la prueba del VIH en los 10 centros de estudio. Resultados El plazo medio para la notificacion de los resultados a un centro sanitario bajo de 44,2 dias antes de la implementacion a 26,7 despues de esta. La reduccion de los plazos fue estadisticamente significativa en 9 (90%) de los centros. El plazo medio de notificacion de un cuidador tambien disminuyo apreciablemente: de 66,8 dias antes de la implementacion a 35,0 dias despues de esta. Solo el 0,5% de los informes enviados como mensaje de texto difirio de los informes por escrito correspondientes. Conclusion El envio mediante mensajes de texto de los resultados de las pruebas del VIH en lactantes redujo de manera significativa los plazos entre la recogida de las muestras y la notificacion de los resultados a los centros sanitarios y a los cuidadores pertinentes., Introduction Despite over three decades of related research and intervention, the global epidemic of human immunodeficiency virus (HIV) infection continues to afflict more than 33 million people worldwide. (1) In [...]

Low rates of treatment failure and death in >6000 cases of children treated for severe pneumonia with oral antibiotics support supports the shift to management of severe pneumonia to outpatients and in the community.Background. Despite advances in childhood pneumonia management, it remains a major killer of children worldwide. We sought to estimate global treatment failure rates in children aged 2–59 months with World Health Organization–defined severe pneumonia.Methods. We pooled data from 4 severe pneumonia studies conducted during 1999–2009 using similar methodologies. We defined treatment failure by day 6 as death, danger signs (inability to drink, convulsions, abnormally sleepy), fever (≥38°C) and lower chest indrawing (LCI; days 2–3), LCI (day 6), or antibiotic change.Results. Among 6398 cases of severe pneumonia from 10 countries, 564 (cluster adjusted: 8.5%; 95% confidence interval [CI], 5.9%–11.5%) failed treatment by day 6. The most common reasons for clinical failure were persistence of fever and LCI or LCI or fever alone (75% of failures). Seventeen (0.3%) children died. Danger signs were uncommon (<1%). Infants 6–11 months and 2–5 months were 2- and 3.5-fold more likely, respectively, to fail treatment (adjusted OR [AOR], 1.8 [95% CI, 1.4–2.3] and AOR, 3.5 [95% CI, 2.8–4.3]) as children aged 12–59 months. Failure was increased 7-fold (AOR, 7.2 [95% CI, 5.0–10.5]) when comparing infants 2–5 months with very fast breathing to children 12–59 months with normal breathing.Conclusions. Our findings demonstrate that severe pneumonia case management with antibiotics at health facilities or in the community is associated with few serious morbidities or deaths across diverse geographic settings and support moves to shift management of severe pneumonia with oral antibiotics to outpatients in the community. [ABSTRACT FROM PUBLISHER]

Objective: Previous studies have demonstrated that HIV-exposed uninfected (HEU) infants and children experience morbidity and mortality at rates exceeding those of their HIV-unexposed uninfected (HUU) counterparts. We sought to summarize the association between HEU vs. HUU infants and children for the outcomes of diarrhea and pneumonia., Design: Meta-analysis., Methods: We reviewed studies comparing infants and children in the 2 groups for these infectious disease outcomes, in any setting, from 1993 to 2018 from 6 databases., Results: We included 12 studies, and 17,955 subjects total [n = 5074 (28.3%) HEU and n = 12,881 (71.7%) HUU]. Random-effects models showed HEU infants and children had a 20% increase in the relative risk of acute diarrhea and a 30% increase in the relative risk of pneumonia when compared with their HUU counterparts. When stratifying by time since birth, we showed that HEU vs. HUU children had a 50% and 70% increased risk of diarrhea and pneumonia, respectively, in the first 6 months of life., Conclusions: We show an increased risk of diarrhea and pneumonia for HEU vs. HUU infants and children. Although we acknowledge, and commend, the immense public health success of prevention of mother-to-child transmission, we now have an enlarging population of children that seem to be vulnerable to not only death, but increased morbidity. We need to turn our attention to understanding the underlying mechanism and designing effective public health solutions. Further longitudinal research is needed to elucidate possible underlying immunological and/or sociological mechanisms that explain these differences in morbidity.

Background: Early initiation of combination antiretroviral therapy (cART) for HIV-positive pregnant women can decrease vertical transmission to less than 5%. Programmatic barriers to early cART include decentralized care, disease-stage assessment delays, and loss to follow-up., Intervention: Our intervention had 3 components: integrated HIV and antenatal services in 1 location with 1 provider, laboratory courier to expedite CD4 counts, and community-based follow-up of women-infant pairs to improve prevention of mother-to-child transmission attendance. Preintervention HIV-positive pregnant women were referred to HIV clinics for disease-stage assessment and cART initiation for advanced disease (CD4 count <350 cells/μL or WHO stage >2)., Methods: We used a quasi-experimental design with preintervention/postintervention evaluations at 6 government antenatal clinics (ANCs) in Southern Province, Zambia. Retrospective clinical data were collected from clinic registers during a 7-month baseline period. Postintervention data were collected from all antiretroviral therapy-naive, HIV-positive pregnant women and their infants presenting to ANC from December 2011 to June 2013., Results: Data from 510 baseline women-infant pairs were analyzed and 624 pregnant women were enrolled during the intervention period. The proportion of HIV-positive pregnant women receiving CD4 counts increased from 50.6% to 77.2% [relative risk (RR) = 1.81; 95% confidence interval (CI): 1.57 to 2.08; P < 0.01]. The proportion of cART-eligible pregnant women initiated on cART increased from 27.5% to 71.5% (RR = 2.25; 95% CI: 1.78 to 2.83; P < 0.01). The proportion of eligible HIV-exposed infants with documented 6-week HIV PCR test increased from 41.9% to 55.8% (RR = 1.33; 95% CI: 1.18 to 1.51; P < 0.01)., Conclusions: Integration of HIV care into ANC and community-based support improved uptake of CD4 counts, proportion of cART-eligible women initiated on cART, and infants tested.