Is early HIV testing of infants in poorly resourced prevention of mother to child transmission programmes unaffordable?

Abstract

Summary Objectives Paediatric HIV infection is predominantly vertically transmitted and 90% of the global burden is carried by Sub Saharan Africa. Diagnosis of HIV infection is important to ensure access to appropriate healthcare. Prevention of mother to child transmission (PMTCT) programmes in low resource settings fail to identify HIV‐infected children because of high lost to follow‐up rates by 12 months of age when HIV testing is performed. The cost of diagnosing HIV infection earlier in infancy was measured. Methods A prospective, longitudinal, descriptive study was conducted in a PMTCT clinic in Johannesburg, South Africa over an 18‐month period. From a total of 300 HIV exposed infants enrolled in an infant diagnostic study, a convenience sample of 30 was enrolled in a costing sub‐study. Patient and provider costs incurred in establishing the HIV status of an exposed infant were documented to determine the societal and provider cost of performing HIV testing at 6 weeks and 12 months of age. Results The average societal cost of an earlier diagnosis of HIV is R158 less per patient than current practice as determined from 123 (82%) questionnaires. On average, early diagnosis would cost the provider R8 more per patient. PMTCT clinic attendance figures predict that earlier testing would increase the number of infants diagnosed by almost threefold. Conclusions A marginal additional investment by government to access an earlier HIV diagnosis for infants could triple the efficacy of PMTCT programmes in identifying HIV‐infected children for medical management and improved quality and quantity of life. Early diagnosis offers societal benefits that extend beyond economic savings.

Human immunodeficiency virus and hepatitis C co-infection in sub-Saharan West Africa

“…81 These problems have contributed to inadequacies in HCV screening facilities in many countries in the region. 44,81 Similarly, even where simple diagnostics tests for HIV are available, facilities for the diagnosis of HIV in infants 92,93 and for HCV may be lacking or simply may not exist. The standard method for the diagnosis of HIV in babies is a polymerase chain reaction (PCR) technique, but such methodology is limited in most sub-Saharan African countries.…”

Clinical Impact and Cost-effectiveness of Diagnosing HIV Infection During Early Infancy in South Africa: Test Timing and Frequency

“…For infants who missed a scheduled test (eg, sensitivity analyses with testing rates of <100%) and for infants infected after 6 or 10 weeks of age, HIV infection was diagnosed only after occurrence of an OI. We also examined 10-week testing and use of postweaning final status tests; postweaning tests are currently recommended but rarely completed (Supplementary Materials) [22,37].…”

Comparative performance evaluation of carbon dot-based paper immunoassay on Whatman filter paper and nitrocellulose paper in the detection of HIV infection

“…Current diagnostic tools detect up to 15 pg/mL and 0.5 pg/mL by conventional ELISA and TSA-mediated signal amplification-boosted ELISA, respectively (Tang and Hewlett 2010;Schüpbach et al 1996;Sutthent et al 2003). While these conventional ELISA detection protocols with greater than 99 % sensitivity are already in use, they are suboptimal because it takes up to 3 months for the antibodies to become detectable in the plasma (Anderson et al 1986;Sherman et al 2005). This problem can be tackled by targeting the HIV-1 capsid protein, p24 antigen, which has been reported to be measureable in blood immediately after infection (Fiebig et al 2003).…”