Birth Diagnosis of HIV Infection on Infants to Reduce Infant Mortality and Monitor for Elimination of Mother-to-Child Transmission.

a Paediatric HIV Diagnostic Syndicate, Wits Health Consortium, Johannesburg, South Africa b Empilweni Services and Research Unit, Department of Paediatrics, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa c National Health Laboratory Service, Johannesburg, South Africa d Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
The Pediatric Infectious Disease Journal (Impact Factor: 3.14). 04/2013; 32(10). DOI: 10.1097/INF.0b013e318290622e
Source: PubMed

ABSTRACT BACKGROUND:: Early initiation of antiretroviral therapy (ART) depends on an early infant diagnosis (EID) and is critical to reduce HIV-related infant mortality. We describe the implementation of a routine Prevention of Mother-to-Child Transmission (PMTCT) program and focus on EID to identify opportunities to improve outcomes. METHODS:: HIV-exposed infants and their mothers were enrolled in a prospective, observational cohort study at a routine, hospital-based PMTCT and HIV treatment service in Johannesburg, South Africa. Infant HIV status was determined by testing samples collected between birth and 6 weeks and searching the national laboratory information system for PCR results of defaulting infants who accessed testing elsewhere. RESULTS:: Of 838 enrolled infants, HIV status was determined for 606 (72.3%) by testing at the study site, 85 (10.1%) by accessing test results from other facilities, 19 (2.3%) by testing stored samples and remained unknown in 128 (15.3%) infants. In total, 38 perinatally HIV-infected infants were identified. Thirty (79%) HIV-infected infants accessed 6-week testing and initiated ART at a median age of 16.0 weeks, but only 14 were in care a median of 68 weeks later and 4 had died. Eight (21%) HIV-infected infants, 2 of whom died, escaped identification by routine testing. Their mothers were younger, more likely to be foreign and accessed less optimal antenatal care. CONCLUSIONS:: Six-week testing delayed ART initiation beyond the time of early HIV-related infant mortality and missed one-fifth of perinatally HIV-infected infants. Earlier diagnosis and improved retention in care are required to reduce infant mortality and accurately measure elimination of MTCT.

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