Improving early identification of HIV‐infected neonates with birth PCR testing in a large urban hospital in Johannesburg, South Africa: successes and challenges

Technau, Karl‐Günter; Kuhn, Louise; Coovadia, Ashraf; Carmona, Sergio; Sherman, Gayle

doi:10.7448/ias.20.01/21436

Cited by 27 publications

(31 citation statements)

References 18 publications

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“…The discrepancy may also be due to the maternal HIV prevalence in our study sample (14.7% at delivery) versus 18.9% for the whole province . In a Johannesburg hospital sample in utero transmission rate was 1.4% during period 3 .…”

Section: Discussionmentioning

confidence: 97%

Neonatal and infant diagnostic HIV‐PCR uptake and associations during three sequential policy periods in Cape Town, South Africa: a longitudinal analysis

et al. 2018

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IntroductionTo strengthen the early infant diagnosis (EID) programmes and timeously identify and treat HIV‐infected infants, birth HIV‐PCR for some/all infants has been recommended in the Western Cape, South Africa since 2014. Operational data on the implementation of such programmes in low‐ and middle‐income countries are limited.MethodsUtilizing the electronic records platform at primary care facilities, we developed an electronic register which consolidated obstetric and HIV‐related data, allowing us to track a cohort of HIV‐infected/exposed mother/infant dyads longitudinally from antenatal care through delivery to infant HIV‐PCR. We assessed guideline implementation and impact on EID of three sequential EID policies in a referral chain of facilities in Cape Town (primary‐tertiary care). Birth HIV‐PCR was indicated in period 1 if symptomatic; period 2 if meeting high‐risk criteria for transmission; and period 3 for all HIV‐exposed neonates.ResultsWe enrolled 2012 HIV‐exposed infants; 89.2% had at least one HIV‐PCR at any point. The majority of birth tests were performed in hospital versus primary care regardless of policy period. Almost half of all infants (47.9%) had at least one high‐risk criterion for vertical infection; of these, 39.7% had a birth test. Infants with more risk factors were more likely to have birth EID. Receipt of a birth HIV‐PCR significantly reduced the likelihood of receiving a follow‐up test at six to ten weeks, even after adjusting for potential confounders (aOR 0.18 (0.12 to 0.26)). The proportion of infants tested at six to ten weeks old dropped from 92.9% (period 1) to 80.2% in period 3 and those receiving birth HIV‐PCR increased, peaking at 67.4% during period 3. The proportion of positive birth tests was highest (2.9%) when birth tests were restricted to infants meeting high‐risk criteria, with a low proportion positive for the first time at six to ten weeks. During period 3, the proportion positive at six to ten weeks was high (2.4%), highlighting the importance of follow‐up to detect intrapartum and early postpartum infections.ConclusionsOver all policy periods, EID guidelines were incompletely implemented across all levels of care but especially in primary care. Birth HIV‐PCR reduced return for follow‐up testing, such follow‐up testing is critical for the effectiveness of the programme.

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Section: Discussionmentioning

confidence: 97%

Neonatal and infant diagnostic HIV‐PCR uptake and associations during three sequential policy periods in Cape Town, South Africa: a longitudinal analysis

et al. 2018

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“…All cohort infants identified as infected at birth were initiated on ART by approximately nine weeks of age. In a pilot program in a South African hospital, nearly all HIV-infected infants who were tested hours after birth were initiated on ART by two weeks of age [ 21 ]. However, timely communication to caregivers for negative results are also important; these results may offer psychosocial benefits to the family and could help to keep mother/infant pairs engaged in care [ 13 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho

Gill

Hoffman

Mokone³

et al. 2017

AIDS Research and Treatment

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Very early infant diagnosis (VEID) (testing within two weeks of life), combined with rapid treatment initiation, could reduce early infant mortality. Our study evaluated turnaround time (TAT) to receipt of infants' HIV test results and ART initiation if HIV-infected, with and without birth testing availability. Data from facility records and national databases were collected for 12 facilities offering VEID, as part of an observational prospective cohort study, and 10 noncohort facilities. HIV-exposed infants born in January–June 2016 and any cohort infant diagnosed as HIV-infected at birth or six weeks were included. The median TAT from blood draw to caregiver result receipt was 76.5 days at birth and 63 and 70 days at six weeks at cohort and noncohort facilities, respectively. HIV-exposed infants tested at birth were approximately one month younger when their caregivers received results versus those tested at six weeks. Infants diagnosed at birth initiated ART about two months earlier (median 6.4 weeks old) than those identified at six weeks (median 14.8 weeks). However, the long TAT for testing at both birth and six weeks illustrates the prolonged process for specimen transport and result return that could compromise the effectiveness of adding VEID to existing overburdened EID systems.

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“…In this study, most women agreed to have their infants tested, adding to the literature suggesting that testing at birth is acceptable. Other studies evaluating birth testing after implementation, including in Lesotho [16] and South Africa [17], also found high acceptance. In Lesotho, the primary reported benefit was earlier knowledge of the child's status, which facilitated better care and relieved the caregiver's anxiety over the child's status [5,16].…”

Section: Discussionmentioning

confidence: 84%

Acceptability and feasibility of testing for HIV infection at birth and linkage to care in rural and urban Zambia: a cross-sectional study

Sutcliffe

Mutanga²,

Moyo

et al. 2020

BMC Infect Dis

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Background: Early infant diagnosis is important for timely identification of HIV-infected infants and linkage to care. Testing at birth has been implemented to facilitate earlier diagnosis of HIV infection but may present new challenges. This study was conducted to understand the acceptability and feasibility of birth testing in urban and rural settings in southern Zambia. Methods: This cross-sectional study was conducted at 11 hospitals and clinics in Livingstone, Choma, and Macha in Southern Province, Zambia from 2016 to 2018. Infants born to pregnant women living with HIV at the sites were eligible for enrollment. After enrollment, a questionnaire was administered to the mother and a dried blood spot card was collected from infants for testing at a central laboratory. When results were available, mothers were notified to return to the clinic. Acceptability of birth testing was evaluated based on the proportion of women who agreed to participate and the reasons for non-participation among women who declined. Feasibility of testing at birth was evaluated using turnaround times for returning results, the proportion of women receiving results, and linkage to care for infants testing positive. Results: One thousand four hundred three women were approached for the study. A small proportion declined due to refusal of birth testing (0 to 8.2% across sites). One thousand two hundred ninety women agreed to have their infants tested. The proportion of mothers receiving results ranged from 51.6 to 92.1%, and was significantly lower at the hospital than clinics in Livingstone (51.6% vs. 69.8%; p < 0.0001) and Macha (69.5% vs. 85.7%; p < 0.0001) but not Choma (85.7% vs. 92.1%; p = 0.34). For mothers who received test results, the median turnaround time from sample collection was 67 days in Livingstone and 53 days in Macha and Choma. Overall, 23 (1.8%) infants tested positive for HIV but only 8 (34.8%) were linked to care a median of 68 days (range: 29, 784) after sample collection. Conclusions: While testing at birth was acceptable, this study highlights the operational challenges under a centralized laboratory testing system. Point-of-care platforms are needed for rapid testing and return of results so HIVinfected children can be identified, linked to care, and treated as early as possible.

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Improving early identification of HIV‐infected neonates with birth PCR testing in a large urban hospital in Johannesburg, South Africa: successes and challenges

Cited by 27 publications

References 18 publications

Neonatal and infant diagnostic HIV‐PCR uptake and associations during three sequential policy periods in Cape Town, South Africa: a longitudinal analysis

Neonatal and infant diagnostic HIV‐PCR uptake and associations during three sequential policy periods in Cape Town, South Africa: a longitudinal analysis

Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho

Acceptability and feasibility of testing for HIV infection at birth and linkage to care in rural and urban Zambia: a cross-sectional study

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