Introduction Mental health problems are prevalent in adolescents living with HIV (ALHIV), often remain untreated, and may negatively affect antiretroviral therapy (ART) adherence and viral suppression. We implemented routine mental health screening at a paediatric ART clinic to improve the identification and management of mental health problems in ALHIV. In this report, we examine screening outcomes, associated patient characteristics and the odds of unsuppressed viral load in ALHIV screening positive for mental disorders. Methods Adolescents aged 10 to 19 years attending Rahima Moosa Hospital in Johannesburg, South Africa between February 1, 2018, and January 1, 2020, were offered mental health screening at each routine HIV care visit. The screening included four pre‐screening questions followed by full screening (conditional on positive pre‐screening) for depression (Patient Health Questionnaire‐9 [PHQ‐9]), suicide (Adolescent Innovations Project [AIP]‐handbook), anxiety (Generalized Anxiety Disorder‐7 [GAD‐7]), post‐traumatic stress disorder (PTSD) (Primary Care PTSD Screen [PC‐PTSD‐5]) and substance use (CAGE Adapted to Include Drugs [CAGE‐AID]). We assessed screening outcomes and calculated adjusted odds ratios for associations between positive screening tests at the first screen and unsuppressed viral load (>400 copies/mL) at the measurement taken closest to the date of screening, within hundred days before and one day after screening. Results Out of 1203 adolescents who attended the clinic, 1088 (90.4%) were pre‐screened of whom 381 (35.0%) underwent full screening, 48 (4.4%) screened positive for depression (PHQ‐9 ≥10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD‐7 ≥10), 38 (3.2%) for PTSD (PC‐PTSD‐5 ≥3), 18 (1.7%) for substance use (CAGE‐AID ≥2) and 97 (8.9%) for any of these conditions. Positive screening for depression (aOR 2.39, 95% CI 1.02 to 5.62), PTSD (aOR 3.18, 95% CI 1.11 to 9.07), substance use (aOR 7.13, 95% CI 1.60 to 31.86), or any condition (aOR 2.17, 95% CI 1.17 to 4.02) were strongly associated with unsuppressed viral load. Conclusions ALHIV affected by mental health problems have increased rates of unsuppressed viral load and need specific clinical attention. The integration of routine mental health screening in paediatric ART programmes is a feasible approach for identifying and referring adolescents with mental health and adherence problems to counselling and psychosocial support services and if needed to psychiatric care.

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Summary: Background: Initiation of antiretroviral therapy (ART) following diagnosis at birth is an emerging area of paediatric HIV care. We present outcomes of HIV-infected infants identified at birth at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa. Methods: From September 2013 (Era 1), only “high risk” HIV-exposed infants were offered diagnostic HIV PCR tests at birth. From June 2014 (Era 2) all HIV-exposed infants were offered laboratory-based diagnostic PCR tests. From October 2014 (Era 3), point-of-care (POC) diagnostic PCR tests were added if staff availability allowed. We describe time to ART initiation, mortality, retention in care and viral suppression among the HIV-infected infants identified across these eras born through June 2016. Findings: Of 5449 HIV-exposed infants tested, 88 confirmed cases of HIV-infection were identified and included in the study; 86 (97·7%) started ART. Age at ART initiation decreased from a median of nine days in Eras 1 and 2 to two days in Era 3. In Era 3, the 35 HIV-infected neonates who were co-tested with POC started ART earlier (82·9% ≤48 hours after birth) than the 29 infants not co-tested (3·5% ≤ 48 hours; median of six days). The probability of mortality by twelve months was 0·14 (95% CI 0·08-0·24) and did not differ by eras. Of the infants who survived and initiated ART at the site, retention at twelve months was 77·8%. Of those infants retained in care, 71·3% had viral load <400 copies/ml at twelve months with no differences between eras. Interpretation: HIV-infected infants can be identified at birth and ART initiated within hours to days. However, reducing mortality and improving retention and viral suppression remain urgent priorities.

This guideline is an update of the post-exposure prophylaxis (PEP) guideline published by the Southern African HIV Clinicians Society in 2008. It updates the recommendations on the use of antiretroviral medications to prevent individuals who have been exposed to a potential HIV source, via either occupational or non-occupational exposure, from becoming infected with HIV. No distinction is made between occupational or non-occupational exposure, and the guideline promotes the provision of PEP with three antiretroviral drugs if the exposure confers a significant transmission risk. The present guideline aligns with the principles of the World Health Organization PEP guidelines (2014), promoting simplification and adherence support to individuals receiving PEP.