Abstract
BackgroundEarly infant diagnosis is important for timely identification of HIV-infected infants and linkage to care. Testing at birth has been implemented to facilitate earlier diagnosis of HIV infection but may present new challenges. This study was conducted to understand the acceptability and feasibility of birth testing in urban and rural settings in southern Zambia.MethodsThis cross-sectional study was conducted at 11 hospitals and clinics in Livingstone, Choma, and Macha in Southern Province, Zambia from 2016 to 2018. Infants born to pregnant women living with HIV at the sites were eligible for enrollment. After enrollment, a questionnaire was administered to the mother and a dried blood spot card was collected from infants for testing at a central laboratory. When results were available, mothers were notified to return to the clinic. Acceptability of birth testing was evaluated based on the proportion of women who agreed to participate and the reasons for non-participation among women who declined. Feasibility of testing at birth was evaluated using turnaround times for returning results, the proportion of women receiving results, and linkage to care for infants testing positive.ResultsOne thousand four hundred three women were approached for the study. A small proportion declined due to refusal of birth testing (0 to 8.2% across sites). One thousand two hundred ninety women agreed to have their infants tested. The proportion of mothers receiving results ranged from 51.6 to 92.1%, and was significantly lower at the hospital than clinics in Livingstone (51.6% vs. 69.8%; p < 0.0001) and Macha (69.5% vs. 85.7%; p < 0.0001) but not Choma (85.7% vs. 92.1%; p = 0.34). For mothers who received test results, the median turnaround time from sample collection was 67 days in Livingstone and 53 days in Macha and Choma. Overall, 23 (1.8%) infants tested positive for HIV but only 8 (34.8%) were linked to care a median of 68 days (range: 29, 784) after sample collection.ConclusionsWhile testing at birth was acceptable, this study highlights the operational challenges under a centralized laboratory testing system. Point-of-care platforms are needed for rapid testing and return of results so HIV-infected children can be identified, linked to care, and treated as early as possible.
Highlights
Infant diagnosis is important for timely identification of Human immunodeficiency virus (HIV)-infected infants and linkage to care
Acceptability of testing at birth During the study period, 1627 pregnant women living with HIV were identified in the maternity wards, including 1403 women with clinically stable infants who were approached for participation in the study (Additional File 3)
A small proportion of women approached at each location declined participation because they did not want their infant tested at birth (0 to 8.2%) or preferred testing at the local post-natal clinic (0 to 3.9%)
Summary
Infant diagnosis is important for timely identification of HIV-infected infants and linkage to care. Despite the scale-up of antiretroviral therapy for pregnant women living with HIV and decreasing rates of mother-to-child transmission, 160,000 children were newly infected with HIV in 2018 [1]. Diagnosing these children and linking them to care and treatment will be key to achieving the 90–90-90 targets for 2020 set by the Joint United Nations Programme on HIV/AIDS [2]. As a result of these challenges, only 63% of infants in eastern and southern Africa and 21% of infants in western and central Africa [9] are tested as recommended by 8 weeks of age [3]
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