Impact of Birth HIV-PCR Testing on the Uptake of Follow-up Early Infant Diagnosis Services in Cape Town, South Africa

Dunning, L. H.; Kroon, Max; Fourie, Lezanne; Ciaranello, Andrea; Myer, Landon

doi:10.1097/inf.0000000000001677

Cited by 26 publications

(36 citation statements)

References 27 publications

(25 reference statements)

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“…Although the uptake of EID testing in the ACC model was high, preliminary data analysis of the national EID data 2018 found that about one-fifth of HIV-exposed infants who were tested received a PCR test at birth, but did not return for the second PCR (GAM report 2018, unpublished). This is consistent with a study in South Africa that reported implementing PCR at birth lowered the uptake of subsequent EID testing at six weeks of age [25]. Details of Thailand's national EID programme, PCR at birth and outcomes of infants receiving birth testing will be reported in separate papers.…”

Section: Discussionsupporting

confidence: 87%

Implementation of an active case management network to identify HIV‐positive infants and accelerate the initiation of antiretroviral therapy, Thailand 2015 to 2018

Lolekha¹,

Pavaputanon

Puthanakit

et al. 2020

J Intern AIDS Soc

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Introduction Early initiation of antiretroviral therapy (ART) can reduce HIV‐related morbidity and mortality in HIV‐positive infants. We implemented an Active Case Management Network to promote early ART initiation Aiming for Cure (ACC) in August 2014. We describe ACC implementation, early infant diagnosis (EID) coverage and ART initiation during August 2014 to July 2018 compared with a national EID survey during October 2007 to September 2011 (pre‐ACC). Methods Thailand's 2014 HIV Treatment Guidelines recommend that HIV‐exposed infants have HIV polymerase chain reaction (PCR) testing at birth, one month and at two to four months. Testing is done at 14 national HIV PCR laboratories. When an HIV‐positive infant (HIV PCR+) is identified, PCR laboratory staff send the result to the hospital staff responsible for the infant's care and to the national laboratory case manager (CM). As part of ACC, the national laboratory CM alerts a regional CM who contacts the hospital staff caring for the infant to offer technical support with ART initiation and ART adherence. CMs enter clinical, demographic and laboratory data into the national ACC database. We analysed the ACC data from August 2014 to July 2018 to assess the ACC's impact on EID coverage, ART initiation and time‐to‐ART initiation. Results The uptake of EID increased from 64% (pre‐ACC) to >95% in 2018 (ACC). The number of HIV‐positive infants born declined from 429 cases (pre‐ACC) to 267 cases (ACC). Median age at the first‐positive PCR declined from 75 days (pre‐ACC) to 60 days (ACC); P < 0.001. Among 429 infants diagnosed before ACC was started, 241 (56%) received ART; during ACC, 235 (88%) of 267 HIV‐positive infants received ART. The median age at ART initiation declined from 282 days before ACC to 83 days during ACC (P < 0.001) and the median time from blood collection to ART initiation declined from 168 days before ACC to 23 days during ACC (P < 0.001). Conclusions An innovative case management network (ACC) has been established in Thailand and results suggest that the network is promoting EID and early ART initiation. The ACC model, using case‐managed PCR notification and follow‐up, may speed ART initiation in other settings.

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Section: Discussionsupporting

confidence: 87%

Implementation of an active case management network to identify HIV‐positive infants and accelerate the initiation of antiretroviral therapy, Thailand 2015 to 2018

Lolekha¹,

Pavaputanon

Puthanakit

et al. 2020

J Intern AIDS Soc

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“…Furthermore, the additional column populating the RTHB identifiers incorporated in the consolidated weekly HIV PCR Results for Action Report, allowed continuous monitoring of uptake and usage of RTHB identifiers among all of the public health facilities in the district. Interestingly, the intra-uterine and intrapartum infection rates among the RTHB identifier cohort are similar to near-contemporaneous birth cohorts described in SA, [7,8] supporting the potential use of RTHB identifiers for EID surveillance.…”

Section: Discussionsupporting

confidence: 61%

Leveraging the Road to Health booklet as a unique patient identifier to monitor the prevention of mother-to-child transmission programme

et al. 2018

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“…Our study provides additional evidence that receipt of birth HIV‐PCR decreased the presentation for follow‐up testing . Receipt of birth EID reduced the likelihood of subsequent HIV testing after six weeks by 82%, even when controlling for other risk factors.…”

Section: Discussionmentioning

confidence: 59%

“…The detection rate between birth and six to ten weeks was lower than at birth (1%) except in period 3; this compares with rates of 0.4 to 0.5% in a hospital cohort during the same period of targeted birth testing . During period 3 there were no positive birth HIV‐PCR results and the detection rate between birth and six to ten weeks was 2.4% (vs. national rates of 1.4% at six weeks .)…”

Section: Discussionmentioning

confidence: 70%

“…In utero transmission was 1.7% on average, highest during periods 1 (3.6%) and 2 (2.3%) when a sample of high‐risk infants was selected. A hospital‐based retrospective cohort study in Cape Town found a similar in utero transmission rate of 3.8% , and the Botswana cohort 3.3% both under programmes of targeted birth EID. When the sample of exposed infants tested at birth is expanded to include those at low risk of infection, a reduced transmission rate would be expected.…”

Section: Discussionmentioning

confidence: 94%

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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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Impact of Birth HIV-PCR Testing on the Uptake of Follow-up Early Infant Diagnosis Services in Cape Town, South Africa

Cited by 26 publications

References 27 publications

Implementation of an active case management network to identify HIV‐positive infants and accelerate the initiation of antiretroviral therapy, Thailand 2015 to 2018

Implementation of an active case management network to identify HIV‐positive infants and accelerate the initiation of antiretroviral therapy, Thailand 2015 to 2018

Leveraging the Road to Health booklet as a unique patient identifier to monitor the prevention of mother-to-child transmission programme

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

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