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Early infant diagnosis of HIV: review of current and innovative practices
Francesca Celletti1, Gayle Sherman, Ahmad H Mazanderani
1aElizabeth Glaser Pediatric AIDS Foundation, Geneva 2 bGeneva School of Diplomacy, Geneva, Switzerland cCentre for HIV & STI, National Institute for Communicable Diseases dDepartment of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg eDepartment of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Insights
Early infant diagnosis (EID) for HIV is critical, but current testing and treatment rates are low. Innovative strategies like point-of-care testing and community support are key to improving outcomes for HIV-exposed infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Early infant diagnosis (EID) of HIV is crucial for timely intervention.
- Current EID testing coverage and antiretroviral therapy initiation rates remain suboptimal.
- Existing programs face challenges in timely result return and linkage to care.
Purpose of the Study:
- To review and discuss strategies for enhancing EID coverage.
- To explore methods for reducing turnaround times for HIV test results.
- To improve the linkage of HIV-infected children to care and treatment.
Main Methods:
- Review of current EID guidelines and successful interventions.
- Analysis of emerging technologies such as point-of-care testing.
- Discussion of community-based approaches and maternal support systems.
Main Results:
- Lower than optimal rates for initial HIV testing (51%) and antiretroviral therapy initiation (49%) in exposed infants.
- Successful interventions include short message service printers, community-based programs, and maternal education.
- Birth testing and EID point-of-care testing show promise for program improvement.
Conclusions:
- Comprehensive interventions tailored to local contexts are needed for EID programs.
- Political and community support are essential for successful EID program implementation.
- Aligning efforts is crucial to prevent HIV-associated morbidity and mortality in children.
Purpose Of Review:
Only 51% of HIV-exposed infants receive an HIV test between 4 and 6 weeks of age, with even lower repeat testing rates at older ages, and only 49% of infants tested are initiated on antiretroviral therapy. The purpose of this article is to discuss potential solutions for increasing coverage of early infant diagnosis (EID), decreasing turnaround time for result return, improving linkages to care and treatment and fulfilling the objective of improving outcomes for HIV-infected children.
Recent Findings:
Differences in HIV testing guidelines have emerged in different countries, with some recommending HIV testing at birth. Although EID programs are not yet optimal, some solutions have proven successful including the use of short message service printers, community-based interventions and support and education of mothers. Birth and EID point-of-care testing have emerged as potential game changers for improving EID programs.
Summary:
For EID programs to impact on child health outcomes, by preventing HIV-associated morbidity and mortality, and provide more value than a mere surveillance tool, efforts need to be aligned toward the implementation of a comprehensive set of interventions that take cognizance of different contexts, epidemiology and health systems, and that are backed by political and community support.
