Birth Diagnosis of HIV Infection in Infants to Reduce Infant Mortality and Monitor for Elimination of Mother-to-child Transmission

Abstract

Six-week testing delayed antiretroviral therapy initiation beyond the time of early HIV-related infant mortality and missed one-fifth of perinatally HIV-infected infants. Earlier diagnosis and improved retention in care are required to reduce infant mortality and accurately measure elimination of mother-to-child transmission.

Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa

“…Mothers with poor health-seeking behaviour are at an increased risk of transmitting HIV because they are less likely to access or adhere to the PMTCT programme or to bring their infants for immunisation visits and PCR testing. [13] Exclusion of these infants together with HIV-infected infants who die before being tested may falsely reduce early vertical transmission rates. The closer EID coverage approaches 100%, the more generalisable the early vertical transmission rates will be to all HIV-exposed infants in SA.…”

Loss of detectability and indeterminate results: Challenges facing HIV infant diagnosis in South Africa’s expanding ART programme

“…HIV-1 PCR testing at 6 weeks has already been found to delay cART initiation in SA's public health sector beyond the time of peak HIV-related infant mortality. [20] Further delays may therefore have fatal consequences, or other serious implications including failure to follow up, the development of drug resistance, negative psychosocial consequences for the caregiver, and considerable cost implications for the public health sector. Although ART levels in untreated breastfed infants have not been sufficiently studied, it has been demonstrated that ART taken by nursing mothers is expressed in significant concentrations in breastmilk.…”

Performance of an Early Infant Diagnostic Test, AmpliSens DNA-HIV-FRT, Using Dried Blood Spots Collected from Children Born to Human Immunodeficiency Virus-Infected Mothers in Ukraine

“…DBS samples serve as suitable practical samples for quality EID in multiple countries (16)(17)(18)(19)(20)(21). To help Ukraine expand its EID services and to increase infants' and children's access to EID in resource-limited settings or remote areas, the performance of Ukraine's EID test, i.e., the AmpliSens assay, as well as the Roche CAP/CTM Qual and Abbott Qualitative assays, was evaluated by using DBS samples from HIV-exposed Ukrainian infants or children; those results were compared with the performance of Ukrainian EID testing using venous whole-blood samples.…”

“…Because of their greater stability at ambient temperature, DBS samples can be transported by postal mail to centralized laboratories for testing and, if packaged correctly, do not raise biosafety concerns regarding the health of postal workers (9)(10)(11)(12)(13)(14)(15). Published data indicate that DBS samples are suitable and practical for quality EID and have aided service expansion in sub-Saharan Africa (16)(17)(18)(19)(20)(21). In our study, for the first time, the performances of the AmpliSens DNA PCR assay and two commercially of Science, Central Research Institute for Epidemiology, Moscow, Russia) instruction manual (28).…”