Page 339 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 5 Original Research

HIV testing at birth: Are we getting it right?

Authors: Background: Birth polymerase chain reaction (PCR) testing improves early detection of HIV
Chanté Bisschoff 1 and allows for early treatment initiation. National guidelines exist, but it is unknown whether
Jasmine Coulon
1
Ziva Isaacs 1 these are being implemented correctly.
Lavinia van der Linde 1 Objectives: To determine whether HIV-exposed infants at the Mangaung University
Linley Wilson 1
Riana van Zyl 1 Community Partnership Programme Community Health Centre (MUCPP CHC) received PCR
Gina Joubert 2 tests at birth, if HIV-positive infants were initiated on treatment, if follow-up dates were
scheduled and the percentage of mothers or caregivers who returned to collect the results.
Affiliations:
1 Department of Paediatrics Methods: The study was a retrospective descriptive file audit (1304 files) of births from
and Child Health, Faculty of 01 January to 31 December 2016 at MUCPP CHC. The study sample was 428 infants born to
Health Sciences, University of
the Free State, Bloemfontein, HIV-positive mothers. The birth register was used to collect the infants’ HIV PCR test barcodes.
South Africa The birth and 10-week PCR results were retrieved from an electronic database at the Virology
Department, University of the Free State.
2 Department of Biostatistics,
Faculty of Health Sciences, Results: In total, 375 infants received a birth PCR test (87.6%) of which 4 (1.1%) tested HIV
University of the Free State, positive and 327 (87.2%) negative. Follow-up tests were not scheduled. However, 145 (44.3%)
Bloemfontein, South Africa HIV-negative infants returned for a 10-week test. Irrespective of the PCR birth result,
Corresponding author: 157 (36.7%) infants were brought for a 10-week follow-up test at which time 3 (1.9%) tested
Riana van Zyl, positive and 151 (96.2%) negative.
[email protected]
Conclusion: The majority of HIV-exposed infants received a PCR test at birth; however, the
Dates: clinic is below the national target (90%) for HIV testing. A record-keeping system of infants’
Received: 29 Jan. 2019 visits does not exist at MUCPP CHC, making it impossible to determine whether HIV-positive
Accepted: 06 May 2019 infants were started on antiretroviral treatment.
Published: 27 June 2019
Keywords: Birth HIV PCR testing; Follow-up testing; Prevention of mother-to-child
How to cite this article:
Bisschoff C, Coulon J, Isaacs Transmission; National guidelines; Documentation; Communication
Z, et al. HIV testing at birth:
Are we getting it right? S Afr J
HIV Med. 2019;20(1), a951. Introduction
https://doi.org/10.4102/
sajhivmed.v20i1.951 The risk of an infant being infected with HIV during pregnancy, delivery or breastfeeding can be
reduced to 5% or less if the mother is on antiretroviral treatment (ART). The highest mortality in
1
Copyright:
© 2019. The Authors. an infant who has acquired HIV is between the ages of 6 weeks to 4 months; therefore, early infant
Licensee: AOSIS. This work diagnosis is imperative in identifying the status of the infant for early introduction of treatment. 1,2,3,4
is licensed under the A South African trial conducted in HIV-positive infants showed improved short-term
Creative Commons neurodevelopmental outcomes because of early initiation of ART, in comparison to infants for
Attribution License.
whom treatment was delayed. Violari et al. found that infant mortality was reduced by 76% and
5
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HIV progression by 75% when infants infected with HIV were diagnosed and placed on ART
before 12 weeks of age.
The South African National Department of Health released the 2015 ‘National consolidated
guidelines for prevention of mother-to-child transmission (PMTCT) and the management of HIV
7
in children, adolescents and adults’ which makes provision for birth HIV polymerase chain
reaction (PCR) testing for all HIV-exposed infants. The reason for the birth PCR was to promote
immediate ART and linkage to care. The infants must receive immediate ART if they test positive
with the first PCR test, and a second PCR test must be performed as a confirmatory test within
1 week after the first PCR test. At 10 weeks, all HIV-exposed but uninfected infants will have a
7,8
repeat PCR. This is performed 4 weeks after the cessation of nevirapine administration. If the
infant is still on nevirapine prophylaxis and the PCR test is performed, there is a possibility of
9
Read online: a false negative or indeterminate result. A definite diagnosis of HIV in infants younger than
Read online:
Scan this QR 18 months of age needs two positive PCR results. 7
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(MUCPP CHC) in the Free State is a large primary health care facility, which consists of an
http://www.sajhivmed.org.za 332 Open Access