Introduction of Routine HIV Birth Testing in the South African National Consolidated Guidelines

Abstract

Universal birth testing for all HIV-exposed neonates is rapidly being achieved in South Africa, facilitating earlier detection of intrauterine infected neonates. However, the successful linkage into care of HIV-infected neonates and their treatment outcomes remain to be assessed.

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

“…Data presented in a review of the first year of the SA National EID Programme demonstrated an increase in birth EID coverage from 39% (high‐risk) to 93% within 12 months of the national guideline change to universal birth testing with a corresponding drop in six‐week testing (to 19%); the increase in ten‐week tests was modest . In our study, the majority of all birth testing occurred in infants born in hospital.…”

“…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. The average in utero transmission rate during the first year of the SA national birth EID programme was 1.1%; when stratified by province it was 2.6% in the Western Cape but the interval overlapped both period 2 and period 3 suggesting that the sample may have been biased towards high‐risk infants and is closer to that in period 2 . 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 .…”

“…This is reflected in an analysis of Western Cape laboratory data in which, while the number of facilities offering birth EID increased during period 2 (high‐risk indication), the majority of tests continued to be performed in hospitals: 67% versus 33% sent from primary care . The national programme data were not stratified by level of care and there are still limited data on how the EID recommendations are implemented in primary care facilities and in rural areas across SA.…”

Monitoring diagnosis, retention in care and viral load suppression in children testing HIV polymerase chain reaction-positive in two districts in South Africa

“…intensified case-finding initiatives, earlier diagnosis of HIV, and accelerated entry into care. [4] While there is evidence of improvements in HIV diagnosis and access to ART among children, [5,6] retention of children in HIV care remains a challenge.…”

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

“…Early infant diagnosis (EID) of HIV, an essential component of the PMTCT programme, includes routine HIV polymerase chain reaction (PCR) testing at birth and 10 weeks of age for all HIV-exposed infants -~260 000 infants per annum in SA. [2] Hence, the RTHB has a pivotal role in improving communication between health workers and caregivers, empowering caregivers, enhancing continuity and co-ordination of care, as well as having the potential to assist with monitoring of national public health programmes, such as the PMTCT programme. [3] Although the World Health Organization (WHO) recommends that patientheld immunisation records be issued with a unique identifier, [1] SA's RTHBs are currently not issued with identifiers, despite being printed and distributed centrally.…”