Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother‐to‐child HIV transmission (EMTCT) efforts

Abstract

Introduction High maternal HIV incidence contributes substantially to mother‐to‐child HIV transmission ( MTCT ) in some settings. Since 2006, HIV retesting during the third trimester and breastfeeding has been recommended by the World Health Organization in higher prevalence (≥5%) settings to reduce MTCT . However, many countries lack clarity on when and how often to retest pregnant and postpartum women to optimize resources and service delivery. We reviewed and characterized national guidelines on maternal retesting based on timing and frequency. Methods We identified 52 countries to represent variations in HIV prevalence, geography, and MTCT priority and searched available national MTCT , HIV testing and HIV treatment policies published between 2007 and 2017 for recommendations on retesting during pregnancy, labour/delivery and postpartum. Recommended retesting frequency and timing was extracted. Country HIV prevalence was classified as: very low (<1%), low (1% to 5%), intermediate (>5 to <15%) and high (≥15%). Women with unknown HIV status at delivery/postpartum were included in retesting guidelines. Results and discussion Overall, policies from 49 countries were identified; 51% from 2015 or later and most (n = 25) were from Africa. Four countries were high HIV prevalence, seven intermediate, sixteen low and twenty‐two very low. Most (n = 31) had guidance on universal voluntary opt‐out HIV testing at the first antenatal care ( ANC ) visit. Beyond the first ANC visit, the majority (78%, n = 38) had guidance on retesting; 22 recommended retesting all women with unknown/negative status, five only if unknown HIV status, three in pregnancy based on risk and eight combining these approaches. Retesting was universally recommended during pregnancy, labour/delivery, and postpartum for all high prevalence settings and four of seven intermediate prevalence settings. Five UNAIDS priority countries for EMTCT with low/very low HIV prevalence, but high/intermediate MTCT , had no guidance on retesting. Conclusions Retesting guidelines for pregnant and postpartum women were ubiquitous in high prevalence countries and defined in some intermediate prevalence countries, but absent in some low HIV prevalence countries with high MTCT . Countries may require additional guidance on how to optimize mate...

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

“…In a recent review of 49 national HIV testing policies, 78% recommended repeat HIV testing. Eleven national guidelines did not include HIV retesting, including several countries identified as priority countries for PMTCT because of their high burden of HIV [45]. In settings where repeat HIV testing is prioritized, programmes should focus on missed opportunities for retesting (e.g.…”

High proportion of unknown HIV exposure status among children aged less than 2 years: An analytical study using the 2015 National AIDS Indicator Survey in Mozambique

“…A recent paper reviewed and characterized the African countries' guidelines on the timing and frequency of maternal retesting. This study reported that in Kenya, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe, regular retesting was part of the norm, but in other countries with a high rate of mother-to-child transmission, they were not consolidated [6].…”

“…Along the prevention of mother-to-child transmission (PMTCT) cascade, several ongoing challenges preclude reaching all women living with HIV and their HIV-exposed infants. In Mozambique, similar with the other priority countries in the African region [6], HIV testing is offered as per the WHO recommendations [7] at the ANCs and other mother and child health (MCH) services such as maternity wards, postpartum care clinics, and family planning clinics. However, systematic data collection on HIV retesting during the pregnancy-breastfeeding period in women with a previous negative test is not being performed.…”

A longitudinal analysis of the completeness of maternal HIV testing, including repeat testing in Cape Town, South Africa

“…HIV-negative/uncertain versus HIV-positive women were more likely to attend ANC (93% vs. 81%; p < 0.001) and presented earlier for their first ANC visit (median gestation (IQR): 21 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) vs. 24 (18-35) weeks; p < 0.001) ( Table 1). At delivery, HIV status was confirmed in 75% of the entire cohort of whom 21% were positive.…”