TRACnet Internet and Short Message Service Technology Improves Time to Antiretroviral Therapy Initiation Among HIV-infected Infants in Rwanda

Abstract

Background: Delays in testing HIV-exposed infants and obtaining results in resource-limited settings contribute to delays for initiating antiretroviral therapy (ART) in infants. To overcome this challenge, Rwanda expanded its national mobile and Internet-based HIV/AIDS informatics system, called TRACnet, to include HIV polymerase chain reaction (PCR) results in 2010. This study was performed to evaluate the impact of TRACnet technology on the time to delivery of test results and the subsequent initiation of ART in HIV-infected infants.

Methods: A retrospective cohort study was conducted on 380 infants who initiated ART in 190 health facilities in Rwanda from March 2010 to June 2013. Program data collected by the TRACnet system were extracted and analyzed.

Results: Since the introduction of TRACnet for processing PCR results, the time to receive results has significantly decreased from a median of 144 days [interquartile range (IQR): 121-197 days] to 23 days (IQR: 17-43 days). The number of days between PCR sampling and health facility receipt of results decreased substantially from a median of 90 days (IQR: 83-158 days) to 5 days (IQR: 2-8 days). After receiving PCR results at a health facility, it takes a median of 44 days (IQR: 32-77 days) before ART initiation. Result turnaround time was significantly associated with time to initiating ART (P < 0.001). An increased number of staff trained for HIV care and treatment was also significantly associated with decreased time to ART initiation (P = 0.004).

Conclusions: The use of mobile technology for communication of HIV PCR results, coupled with well-trained and skilled personnel, can reduce delays in communicating results to providers. Such reductions may improve timely ART initiation in resource-limited settings.

Figure 1

Outline of Early Infant Diagnosis (EID) process (numbers) and potential delays (letters) from initial sampling to antiretroviral therapy (ART) initiation. 1) Facility collects the sample and fills in the DBS form; 2) sample receipt and coding at National Reference Laboratory (NRL); 3) NRL processes sample and results are added to the DBS form and TRACnet; 4) TRACnet triggers and sends an SMS with PCR results under the associated code to the 2 contact persons at the health facility (automatic report is generated for the PMTCT service); 5) facility contacts match the results to infants using the code and enter the results into the medical record. They then follow up with all infants testing positive to start on ART. Sources of potential delay include: A) sample collection at health facility till receipt at NRL (transport); B) sample receipt till result complete (processing); C) result complete till received at health facility (transmission); and D) result received till ART initiation (provider). The total time from sample collection to result receipt at health facility is the PCR turnaround (E), and the total time from DBS to ART initiation is denoted as (F).

Figure 2

Trends for HIV PCR results turnaround time (2010-2013)