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Optimizing Infant HIV Diagnosis in Resource-Limited Settings: Modeling the Impact of HIV DNA PCR Testing at Birth
Alexander Chiu1, Surbhi Modi, Emilia D Rivadeneira
1*Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA; and†The CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA.
Insights
Adding HIV testing at birth for infants can significantly increase early antiretroviral therapy (ART) initiation and reduce infant deaths. This strategy improves survival rates in resource-limited settings.
Area of Science:
- Pediatrics
- Public Health
- Infectious Diseases
Background:
- Early antiretroviral therapy (ART) initiation is crucial for HIV-infected infants' survival but faces delays in resource-limited settings.
- Current infant HIV testing at 4-6 weeks may not be timely enough to prevent mortality.
- Implementing HIV testing at birth could accelerate diagnosis and treatment.
Purpose of the Study:
- To model the benefits of adding infant HIV testing at birth to the existing testing algorithm.
- To assess the impact on ART initiation rates and infant survival.
Main Methods:
- A decision-tree model was developed using Microsoft Excel for HIV-infected women and infants in sub-Saharan Africa.
- The model incorporated data on facility births, prevention of mother-to-child HIV transmission (PMTCT) utilization, transmission rates, and ART initiation.
- Sensitivity analyses were performed, and the model was applied to country-specific data.
Main Results:
- Adding HIV testing at birth could increase the number of infants on ART by 204% by 18 months.
- Early ART initiations (by 3 months) could increase by 543%.
- This intervention is projected to prevent 5108 infant deaths by 12 months of age.
Conclusions:
- Testing HIV-infected infants at birth can significantly improve the number and timeliness of ART initiation.
- This strategy holds the potential to substantially decrease infant mortality.
- Countries should consider integrating birth testing with early infant testing for optimal outcomes.
Background:
Early antiretroviral therapy (ART) initiation in HIV-infected infants significantly improves survival but is often delayed in resource-limited settings. Adding HIV testing of infants at birth to the current recommendation of testing at age 4-6 weeks may improve testing rates and decrease time to ART initiation. We modeled the benefit of adding HIV testing at birth to the current 6-week testing algorithm.
Methods:
Microsoft Excel was used to create a decision-tree model of the care continuum for the estimated 1,400,000 HIV-infected women and their infants in sub-Saharan Africa in 2012. The model assumed average published rates for facility births (42.9%), prevention of mother-to-child HIV transmission utilization (63%), mother-to-child-transmission rates based on prevention of mother-to-child HIV transmission regimen (5%-40%), return of test results (41%), enrollment in HIV care (52%), and ART initiation (54%). We conducted sensitivity analyses to model the impact of key variables and applied the model to specific country examples.
Results:
Adding HIV testing at birth would increase the number of infants on ART by 204% by age 18 months. The greatest increase is seen in early ART initiations (543% by age 3 months). The increase would lead to a corresponding increase in survival at 12 months of age, with 5108 fewer infant deaths (44,550, versus 49,658).
Conclusion:
Adding HIV testing at birth has the potential to improve the number and timing of ART initiation of HIV-infected infants, leading to a decrease in infant mortality. Using this model, countries should investigate a combination of HIV testing at birth and during the early infant period.
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