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

Missed diagnostic opportunities within South Africa’s early infant diagnosis program, 2010–2015

“…For example, the increased exposure to ART prophylaxis amongst infants, associated with WHO Option B/B+, as well as the introduction of routine birth testing within the EID programme have both been posited as potential contributing factors towards indeterminate and invalid HIV PCR results [25]. However, the proportion of indeterminate results has remained fairly constant since 2011.…”

“…Understanding where errors occur within the testing process can assist with redesigning systems that render it difficult for health-care professionals to make mistakes, thereby reducing wastage of resources both within the clinic and laboratory [24]. Furthermore, due to the dramatic increase in the volume of testing performed over recent years as well as concerns that changes within the PMTCT program and testing landscape could impact negatively on diagnostic quality [25,26], assessing the trend of MDOs is imperative. Towards this end we describe HIV PCR test rejections and indeterminate results, and the associated delay in diagnosis, within South Africa’s early infant diagnosis program from 2010 to 2015.…”

Recommendations for the medical evaluation of children prior to adoption in South Africa

“…Furthermore, in the context of PMTCT practices, repeat HIV PCR testing 4 -6 weeks after cessation of prophylaxis may be prudent in view of increasing evidence suggesting that molecular HIV testing may not detect low-level viraemia as a result of antiretroviral therapy. [21,22] Since it is not possible to exclude HIV infection completely in early infancy, prospective adoptive parents need to be counselled in this regard.…”

Universal children's day – let's improve current interventions to reduce vertical transmission of HIV now

“…In one report, a PCR at 4–6 weeks of age in formula-fed infants missed 32% of infections found at three months of age. Other studies have confirmed the inaccuracy of a single PCR at 4–6 weeks of age [21,22]. Point of care virological testing may be useful on the first day of life particularly where there is a high transmission risk but is not essential provided that at least two blood specimens are drawn for PCR in the first few days of life and triple ARV prophylaxis is initiated as soon as possible after birth.…”