Page 342 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 5 Original Research

classified as post-maternal. Pregnancies in either very young second test could have been confirmatory, the 2015 national
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women (teenagers younger than 18 years) or women older guidelines state that the confirmatory test should be
than 35 years (advanced maternal age) are considered to be performed within 1 week of a positive birth PCR result.
high-risk pregnancies. Especially, teenage pregnancy and
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multiparity carry an increased risk of maternal HIV infection During the study, we could not find evidence that specific
and vertical transmission. follow-up dates or a general time frame was given to the
mother to return for the birth PCR results or repeat testing at
The percentage of HIV-positive mothers on ART at MUCPP 10 weeks. We postulate that mothers were informed at the
CHC is comparable to the 95.0% of pregnant HIV-positive first vaccination visit at 6 weeks that a repeat PCR should be
women in South Africa on ART in 2016. 11 performed at 10 weeks. A specific date should be given so
that the mothers or caregivers know exactly when to come
The results showed that 87.6% (375/428) of HIV-exposed back. According to the national guidelines, 10 weeks is the
infants born at MUCPP CHC during 2016 received a birth correct follow-up date because it is essential to do the HIV
PCR test. The national target for HIV testing in the general PCR test 4 weeks after having stopped nevirapine
population in South Africa is 90.0%. The 2015 national prophylaxis. Nevirapine use could produce a false negative
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guidelines also state that all HIV-exposed infants should or indeterminate result. 7,9
receive a birth PCR test as early diagnosis is essential to
decrease HIV-related deaths in infants. Of the mothers or caregivers who brought the infants back
for a follow-up PCR test, either before, during or after the 10-
It is possible that not all nurses were aware of the 2015 week time frame, we speculate that these are the mothers or
national guidelines and they still follow the 2010 national caregivers who collected the birth PCR results. Possible
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guidelines in which the first HIV PCR test is performed only reasons why the mother or caregiver did not bring the infant
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at 6 weeks of age while the mother receives a viral load test of back for follow-up PCR testing are lack of transport, lack of
delivery. This practice seemed to be employed by staff money for transport, relocation, forgotten appointments
working at the clinic during November. Different staff and/or social and family issues.
members also seem to have differing levels of phlebotomy
expertise, with those working in July having a particularly Study limitations
high percentage of insufficient specimens.
It was difficult to find the 10-week results via NHLS. This
may be because of the infant’s name, surname or residential
Four (1.2%) infants out of the 331 infants with birth PCR address changing from the time of birth.
results tested HIV-positive at birth. Any infant with a positive
birth PCR result should be referred to or discussed No further information was captured for the 53 infants who
telephonically with a paediatric HIV specialist for ART
initiation. As we found no record-keeping system of the were not tested at birth.
infants’ visits, it was not possible to determine whether ART
was initiated in HIV-positive infants. The 2015 national Conclusion
guidelines state that all PCR results should be documented; The researchers found that 87.6% of HIV-exposed infants
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however, this information is only recorded in the infant’s received a birth HIV PCR test, which approaches the national
Road to Health (RTH) booklet that stays in the mother’s or target of 90.0%. There were no follow-up dates given for
caregiver’s possession. Only the mother’s details are recorded infants who tested negative at birth. The mothers or
in the appointment book at the paediatric clinic. caregivers of those who tested positive at birth were
telephonically contacted to return so that initiation of ART
In the authors’ opinion, there is poor communication between could commence, but no record was maintained. The authors
the maternity ward and paediatric clinic at MUCPP CHC speculate that 57.3% of mothers or caregivers who came back
because the maternity ward was under the impression that for a follow-up test received the birth PCR test results.
the paediatric clinic received the infant PCR results, which
was not the case. As a result, none of these departments Therefore, MUCPP CHC is partially adhering to the 2015
recorded any information in their files about the PCR results national guidelines as the majority of HIV-exposed infants
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or whether the infant was tested. Thus, the researchers used are being tested at birth. However, they do not ensure that
the NHLS electronic database to get this information. The negative cases are retested to identify intrapartum infection.
maternity ward sister indicated to the researchers that As only the mothers’ details were recorded at the paediatric
the mothers or caregivers were contacted telephonically if clinic, it could not be determined whether the infants who
the birth HIV PCR was positive. were HIV-positive were initiated on ART or whether a
confirmatory PCR test was performed.
Of the four infants who tested positive at birth, one was
retested at 10 weeks and remained HIV-positive. We speculate The national guidelines state that all HIV PCR results should be
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that this infant was possibly not on ART and that the birth documented. However, this information is recorded in the RTH
result was lost, necessitating a repeat PCR. Although the booklet, which stays with the mothers or caregivers. As of 2017,

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