Performance of point-of-care birth HIV testing in primary health care clinics: An observational cohort study

Area of Science:

• Global Health
• Infectious Diseases
• Public Health

Background:

• Timely diagnosis of HIV in infants is crucial for effective pediatric antiretroviral treatment (ART) scale-up.
• Current HIV diagnostic methods take 2-3 weeks, hindering timely care, especially in resource-limited settings.
• The World Health Organization (WHO) recommends birth testing for early HIV diagnosis and improved coverage.

Purpose of the Study:

• To evaluate the benefits of implementing rapid, point-of-care (POC) HIV testing at birth in primary healthcare maternity wards in Mozambique.
• To assess the feasibility and accuracy of on-site POC HIV testing compared to standard laboratory methods for infants born to HIV-infected mothers.

Main Methods:

• A prospective implementation research study was conducted in eight primary healthcare clinics in Mozambique.
• 2,350 HIV-exposed infants were tested within 24 hours of delivery using both on-site POC and standard laboratory assays.
• Infants were also tested at 4-6 weeks of age using both methods for comparison.

Main Results:

• POC testing at birth demonstrated 100% sensitivity and 100% specificity compared to laboratory testing.
• Testing at birth and 4-6 weeks identified 71 HIV-positive infants, a 16% increase compared to testing at 4-6 weeks alone.
• 29 out of 61 (47.5%) infants identified as HIV-positive at 4-6 weeks had a positive test at birth.

Conclusions:

• Integrating POC birth testing into primary healthcare settings can enhance HIV diagnosis and accelerate ART initiation for infants.
• Further guidance is needed on appropriate confirmatory HIV testing algorithms for birth testing strategies.
• Rapid infant HIV diagnosis at birth is a viable strategy to improve pediatric ART access in low-resource environments.