An analysis of the HIV testing cascade of a group of HIV-exposed infants from birth to 18 months in peri-urban Khayelitsha, South Africa

• Published in: PloS one Vol. 17; no. 1; p. e0262518
• Main Authors: Nelson, Aurelie Kennedy, Cassidy, Tali, Trivino Duran, Laura, Cox, Vivian, Wedderburn, Catherine J, Giddy, Janet, Pieters, Pauline, Cotton, Mark F, Mutseyekwa, Tabitha, Rorwana, Bulelwa, Sibanda, Beryl, Bernheimer, Jonathan, Matise, Nopinky, Isaakidis, Petros, Maritz, Jean
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.01.2022; Public Library of Science (PLoS)
• Subjects: Analysis; Anti-HIV Agents - therapeutic use; Babies; Biology and Life Sciences; Birth; Breast Feeding; Children & youth; Childrens health; Cohort Studies; Diagnosis; Disease prevention; Disease transmission; Drug therapy; Exposure; Families & family life; Female; Health care; HIV; HIV - pathogenicity; HIV infection in children; HIV Infections - diagnosis; HIV Infections - transmission; HIV Infections - virology; HIV testing; HIV Testing - methods; Hospitals; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infants; Infectious Disease Transmission, Vertical - prevention & control; Infectious Disease Transmission, Vertical - statistics & numerical data; Laboratories; Male; Medical diagnosis; Medical tests; Medicine; Medicine and Health Sciences; Mothers; Nurses; Patient compliance; Pediatric research; Pediatrics; People and Places; Point-of-Care Testing; Polymerase Chain Reaction - methods; Pregnancy; Primary care; Public health; Research and Analysis Methods; Risk factors; South Africa - epidemiology; Subgroups; Tracers; Tracing; Virology; South Africa; Cape Town South Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0262518

Despite the reduction of HIV mother-to-child transmission, there are concerns regarding transmission rate in the breastfeeding period. We describe the routine uptake of 6 or 10 (6/10) weeks, 9 months and 18 months testing, with and without tracing, in a cohort of infants who received HIV PCR testing at birth (birth PCR) (with and without point of care (POC) testing) in a peri-urban primary health care setting in Khayelitsha, South Africa. In this cohort study conducted between November 2014 and February 2018, HIV-positive mothers and their HIV-exposed babies were recruited at birth and all babies were tested with birth PCR. Results of routine 6/10 weeks PCR, 9 months and 18 months testing were followed up by a patient tracer. We compared testing at 6/10 weeks with a subgroup from historical cohort who was not tested with birth PCR. We found that the uptake of 6/10 weeks testing was 77%, compared to 82% with tracing. When including all infants in the cascade and comparing to a historical cohort without birth testing, we found that infants who tested a birth were 22% more likely to have a 6/10 weeks test compared to those not tested at birth. There was no significant difference between the uptake of 6/10 weeks testing after birth PCR POC versus birth PCR testing without POC. Uptake of 9 months and 18 months testing was 39% and 24% respectively. With intense tracing efforts, uptake increased to 45% and 34% respectively. Uptake of HIV testing for HIV-exposed uninfected infants in the first 18 months of life shows good completion of the 6/10 weeks PCR but suboptimal uptake of HIV testing at 9 months and 18 months, despite tracing efforts. Birth PCR testing did not negatively affect uptake of the 6/10 weeks HIV test compared to no birth PCR testing.