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Infant HIV Testing Amid the COVID-19 Pandemic and Evolving PMTCT Guidelines in Johannesburg, South Africa
Coceka N Mnyani1, Andomei Smit1, Gayle G Sherman2,3
1Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa.
Insights
Despite COVID-19 disruptions, infant HIV testing in Johannesburg successfully implemented updated guidelines. The number of HIV PCR tests increased, while new pediatric HIV diagnoses decreased, showing progress in preventing mother-to-child transmission.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatric HIV/AIDS
Background:
- COVID-19 pandemic significantly impacted global health programs, including HIV services.
- Resource diversion and lockdown measures posed challenges to HIV prevention and treatment efforts.
- Updated 2019 guidelines for preventing mother-to-child transmission of HIV (PMTCT) were implemented in Johannesburg.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic on infant HIV diagnosis.
- To evaluate the implementation of updated 2019 PMTCT guidelines amidst the pandemic.
- To analyze trends in infant HIV testing and diagnosis in Johannesburg, South Africa.
Main Methods:
- Retrospective analysis of HIV PCR data for children under 2 years old.
- Data extracted from the National Health Laboratory Service database (October 2018 - September 2021).
- Trends examined by age, lockdown levels, and guideline implementation.
Main Results:
- Total HIV PCR tests increased year-on-year (41,879 to 56,813).
- Total pediatric HIV diagnoses decreased year-on-year (659 to 620).
- A temporary dip in diagnoses occurred during the strictest lockdown (Q2 2020), followed by a rebound.
Conclusions:
- Successful implementation of updated PMTCT guidelines occurred despite COVID-19 challenges.
- Infant HIV testing experienced minimal disruption, with increased testing volumes.
- Continued efforts are necessary to achieve the elimination of mother-to-child transmission of HIV.
Abstract:
Background: The COVID-19 pandemic impacted HIV programmes with the diversion of resources and lockdown measures. We assessed the impact of COVID-19 on infant HIV diagnosis in the context of updated 2019 prevention of mother-to-child transmission of HIV (PMTCT) guidelines in Johannesburg, South Africa. Methods: HIV PCR data for children <2 years were extracted from the National Health Laboratory Service database from October 2018 to September 2021, inclusive. Trends in the total number of tests performed and the total number of children with HIV diagnosed, stratified by age, were determined to assess the effect of different COVID-19 lockdown levels and updated guidelines. Results: When comparing three 12-month periods ending September 2019−2021, respectively, the total number of HIV PCR tests performed increased (from 41 879 to 47 265 to 56 813), and the total number of children with HIV decreased (from 659 to 640 to 620), year-on-year. There was a substantial increase in 6-month testing in response to updated guidelines. Excluding 6-month testing, the year-on-year increase in total tests was maintained with birth and 10-week testing closely approximating total live births to women living with HIV. A decrease in the total number of children with HIV diagnosed was noted in Q2 2020, coinciding with the most restrictive lockdown, followed by a rebound in cases. Conclusions: Despite the restrictions and diversion of resources associated with COVID-19, there was a successful implementation of PMTCT guideline updates and minimal disruption to infant HIV testing. However, much work remains in order to achieve the elimination of mother-to-child transmission of HIV.
