1. Building EID Programs Highlights –Bulk purchase of PCR kits reduces cost – now at around 8 USD per test –Supplying DNA PCR tests – with bundles for DBS collection and lab consumables –Ensuring access to laboratory services through sample transportation and handling network –Kenya –Lesotho –Global view of EID access in 2008 –Building EID programs is not enough!

2. Building EID Programs Highlights –Bulk purchase of PCR kits reduces cost – now at around 8 USD per test –Supplying DNA PCR tests – with bundles for DBS collection and lab consumables –Ensuring access to laboratory services through sample transportation and handling network –Kenya –Lesotho –Global view of EID access in 2008 –Building EID programs is not enough!

3. DBS sample collection networks for EID Dried blood spots (DBS) are stable at RT, and safe to transport, enabling a small number of PCR labs to serve a large proportion of the population Clinic Site Central DNA PCR testing lab 1 Clinic site sends infant specimen with requisition for new DBS supplies 2 Lab performs test and sends result back to site with more DBS supplies Known exposed Infants from pMTCT Symptomatic infants from ward Asymptomatic infants identified through routine screening Supply of PCR kits and DBS supplies 3 Site clinicians review results and refer for ART evaluation if needed Referral to comprehensive care environment

4. Kenya DNA PCR DBS network 237 15 58 1470 96 124 15 1128 EID using DNA PCR is available at 4 facilities (Kisumu, Kericho, Nairobi, AMPATH) BUT the clinical service is available to public facilities with access supervised by NASCOP > 200 sites 1-day DBS collection training provided at the facilities A professional courier, Securicor transports samples and results Collaborative worked in partnership with CDC to support the government

5. Lesotho: outsourced DNA PCR Testing Lesotho wanted to start EID program rapidly but had no capacity for DNA PCR in-country Lesotho formed a partnership with NICD in South Africa to perform DNA PCR on Lesotho’s DBS samples Clinics in Lesotho collect DBS samples to send to Central Lab in Maseru Central Lab uses DHL to mail samples to NICD for testing NICD conducts the test, and charges Lesotho for its operating costs; Results turnaround time – 4 weeks

6. EID forecasted in 2008 1)Number of Infants Tested: ~280,000 infants These are estimates Several countries have estimated for EID but not yet approved PCR 2) Number of Collection Sites: ~1,300 3) Products to Be Purchased: ~4,000 PCR Kits Kits are needed with DBS bundles and consumables for DNA PCR Does not include countries that use VL used for EID Does not include certain high volume countries eg RSA Brazil, Argentina, Mexico

7. Follow up follow up follow up follow up Poor follow up is a huge issue: Recent survey of the Early Infant Diagnosis program in Kenya showed a marked drop out rate between testing and treatment Putting EID in place does not automatically result in more kids being enrolled on ART