The authors were interested in the efficacy of the HIV Infant Tracking (HIT)System, a web-based way of linking providers of early infant diagnosis, laboratory technicians and mothers and infants to improve outcomes from early infant diagnosis. They performed a cluster-randomised trial in six hospitals in Kenya, randomly allocating them within a matched pair to either the HITSystem (intervention, n=3) or standard of care (control, n=3). Eligible participants were mothers aged ≥18 years with an infant <24 weeks presenting for their first early infant diagnosis appointment. 895 mother-infant pairs were enrolled. Of these, 87 were judged ineligible for analysis, 26 infants died and 92 pairs moved or were transferred to another healthcare facility. The authors therefore analysed data from 690 mother-infant pairs, of whom 392 were allocated to the HITSystem and 298 to the standard of care. Infants who were diagnosed as HIV-infected were followed-up for a median of 2·1 months and HIV-uninfected infants for a median of 17·0 months. The authors found that infants enrolled in the HITSystem were significantly more likely to receive complete early infant diagnosis services compared with those receiving standard of care (85% vs. 60%, adjusted odds ratio [aOR] 3·7, 95%CI 2·5-5·5). Interesting there was no effect of the intervention seen at high-volume hospitals, but strong effects were seen at medium- and low-volume hospitals. The modified intention-to-treat analyses for complete early infant diagnosis were also found to be significant (70% vs. 54%, aOR 2·0, 95%CI 1·4-2·7). Therefore the HITSystem is an effective and feasible intervention in low-resource settings.
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