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Retention in care of infants diagnosed with HIV at birth: Beyond the diagnostic strategy
Michael J Christie1, Nicolette M du Plessis1
1Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Insights
Point-of-care (POC) HIV testing for infants significantly reduced turnaround time but did not improve 6-month retention in care. Further strategies are needed to enhance follow-up post antiretroviral therapy (ART) initiation.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- Diagnostic technologies
Background:
- Birth HIV point-of-care (POC) tests expedite diagnosis and improve mother-infant engagement.
- High rates of infant loss to follow-up occur within six months of antiretroviral therapy (ART) initiation.
Purpose of the Study:
- To compare 6-month retention in care, HIV viral load (VL) suppression, and mortality in infants diagnosed at birth using laboratory-based versus POC HIV PCR testing.
- To evaluate the impact of POC testing on early infant diagnosis and ART initiation outcomes.
Main Methods:
- A comparative study of HIV-exposed infants from 2018-2019 (POC testing) versus a historical control group (2014-2016, laboratory-based testing).
- Outcomes assessed included time to diagnosis, time to ART initiation, 6-month retention in care, HIV viral suppression, and mortality.
- Fifty-seven infants were analyzed (POC: 27, Control: 30).
Main Results:
- POC testing significantly reduced turnaround time (15.5h vs. 68.3h, p < 0.0001).
- Time from HIV diagnosis to ART initiation was similar between groups (median 13 days).
- Six-month care retention was 72% overall, higher in the control group (77% vs. 67%). HIV viral suppression was higher in the POC group (78% vs. 47%, p=0.09). No deaths were reported.
Conclusions:
- While POC testing accelerates HIV diagnosis, it did not improve 6-month retention in care.
- Strategies to address loss to follow-up are crucial, especially during initial mother-infant visits post-ART initiation.
- Improving retention is essential to maximize benefits of early HIV diagnosis and treatment.
Background:
Birth HIV point-of-care (POC) tests curtail analytical testing issues and expedite diagnosis, potentially allowing for earlier mother-infant pair engagement and improved outcomes. Many children are lost post antiretroviral therapy (ART) initiation within the first 6 months of follow-up.
Objectives:
We compared 6-month retention in care, HIV viral load (VL) suppression and mortality among infants diagnosed with HIV at birth, using laboratory-based versus POC HIV PCR testing.
Method:
From 2018 to 2019, infants exposed to HIV underwent birth HIV PCR POC testing at Kalafong Provincial Tertiary Hospital in Tshwane District. Their outcomes were compared to a historical control born between 2014 and 2016, who exclusively underwent laboratory-based HIV PCR testing. Both groups received comparable HIV care following national guidelines.
Results:
Fifty-seven infants were studied (POC: 27; Control: 30). The POC turnaround time was significantly shorter (POC: 15.5 h [IQR: 4.3-24.7], Control: 68.3 h [IQR 46.0-93.9]; p = < 0.0001). Both populations had the same elapsed time from HIV diagnosis to ART initiation (median: 13 days, POC: IQR 8-21 days; Control: IQR 9-36 days). Six infants were never initiated (POC: 2 [7%]; Control: 4 [13%]). At 6 months, overall care retention was 72% (41/57), higher among the Control group (Control 23/30, 77%; POC: 18/27, 67%). HIV viral suppression at 6 months was higher among the POC group (POC: 14/18, 78%; Control: 9/19, 47%, p = 0.09). No deaths were reported.
Conclusion:
Poor care retention at 6 months post ART initiation is concerning. Initial mother-infant visits should be effectively utilised to assess and manage potential risk factors for loss of follow-up.
Contribution:
This study highlights the ongoing need to find workable solutions to improve retention in care, thereby ensuring the benefits of expedited HIV diagnosis and ART initiation.
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