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The Cascade of Care From Routine Point-of-Care HIV Testing at Birth: Results From an 18-Months Pilot Program in
Philisiwe Ntombenhle Khumalo1, Emma Sacks2, Caspian Chouraya3
1Research and Public Health Evaluation, Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini.
Insights
Point-of-care HIV testing at birth in Eswatini showed high uptake and successful initiation of antiretroviral therapy (ART) for infected infants. This approach demonstrated good retention in care and viral suppression, improving early HIV treatment outcomes.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- Global Health
Background:
- HIV testing at birth is crucial for early infant treatment but faces challenges in feasibility and retention.
- In 2017, Eswatini implemented point-of-care (POC) HIV birth testing in routine maternity care at three high-volume facilities.
Purpose of the Study:
- To evaluate the uptake, effectiveness, and outcomes of POC HIV birth testing in Eswatini.
- To assess the initiation of antiretroviral therapy (ART), retention in care, and viral suppression among HIV-positive infants identified at birth.
Main Methods:
- POC HIV birth testing was offered to HIV-exposed infants (HEI) within three days of birth.
- Data collected from August 2017 to November 2018 included birth testing, 6-8 week retesting for negative infants, and six-month retention/viral load for positive infants.
Main Results:
- Of 4322 eligible HEI, 76.6% were tested, identifying 26 HIV-positive infants (0.8% positivity).
- 96.1% of HIV-positive infants initiated ART, with 84% retained at 6 months and 84.2% virally suppressed.
- 91.3% of infants testing negative at birth were retested at 6-8 weeks, identifying an additional 9 HIV-positive cases.
Conclusions:
- POC HIV birth testing in Eswatini achieved high uptake and successfully initiated ART for infected infants.
- High retention in care and viral suppression were observed among infants identified through birth testing.
- Birth testing did not significantly decrease the need for subsequent 6-8 week testing.
Background:
HIV testing at birth may improve early treatment, but concerns remain about feasibility and retention of infants in care. In 2017, point-of-care (POC) HIV birth testing was introduced into routine care at 3 high-volume maternity health facilities in Eswatini.
Methods:
POC birth testing was offered to HIV-exposed infants (HEI) born at, or presenting to, 3 maternities within 3 days of birth. Data were collected from a project-specific EID test request form and routine registers on all tests conducted from August 1, 2017 to November 30, 2018, including retesting at 6-8 weeks for infants testing negative at birth and six-month retention in HIV care and viral load suppression among infants testing HIV-positive at birth.
Results:
Of 4322 eligible HEI, 3311 (76.6%) were tested. Twenty-six HIV-infected infants were identified (positivity rate 0.8%) and 25 initiated on antiretroviral therapy (ART) (96.1%). The median time from sample collection to ART initiation was 20.50 days (IQR 14-45). Twenty-one (84%) ART-initiated infants were on ART at 6 months after initiation. Nineteen infants (90.5%) had viral load test information at 6 months and 16 (84.2%) were virally suppressed. Of 3126 HEI testing negative at birth, 3004 (96.1%) were linked to laboratory databases and 2744 (91.3%) were retested at 6-8 weeks, with 9 (0.3%) additional infants testing HIV-positive.
Conclusions:
Uptake of POC birth testing was high in Eswatini with low HIV positivity. Almost all infants identified HIV-positive at birth were initiated on ART, with high retention in care and viral suppression. Birth testing did not seem to significantly reduce subsequent 6-8-week testing.
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