Linkage of HIV-Infected Infants from Diagnosis to Antiretroviral Therapy Services across the Western Cape, South Africa

Grace C John-Stewart,Nei-Yuan Hsiao,Landon Myer,Kathryn Stinson

doi:10.1371/journal.pone.0055308

Grace C John-Stewart, Nei-Yuan Hsiao + Show 2 more

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https://doi.org/10.1371/journal.pone.0055308

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Abstract

IntroductionEarly infant diagnosis (EID) of HIV infection is an important service to reduce paediatric morbidity and mortality related to HIV/AIDS. Although South Africa has a national EID programme based on PCR testing, there are no population-wide data on the linkage of infants testing HIV PCR-positive to HIV care and treatment services.MethodsWe conducted a retrospective analysis of all public sector laboratory data from across the Western Cape province between 2005 and 2011. We linked positive HIV PCR results to subsequent HIV viral load testing to determine the proportion of infants who were successfully linked to HIV care.ResultsA total of 83 698 unique infant HIV PCR tests were documented, of which 6322 (8%) were PCR positive. The proportion of PCR-positive children declined from 12% in 2005 to 3% in 2011. Of the children testing PCR-positive, 4105 (65%) had subsequent viral load testing indicating successful linkage to care. The proportion of successfully linked infants increased from 54% in 2005 to 71% in 2010, while the median delay in days to successful linkage decreased from 146 days in 2005 to 33 days in 2010.DiscussionFrom 2005 to 2011 there has been a reduction in the proportion of children testing HIV PCR-positive, and an increase in the proportion of infected infants successfully linked to HIV care and treatment, in this setting. However a large proportion of infected infants remain unlinked to antiretroviral therapy services and there is a clear need for interventions to further strengthen EID programmes.

Highlights

Infant diagnosis (EID) of HIV infection is an important service to reduce paediatric morbidity and mortality related to HIV/AIDS
Thirteen percent of polymerase chain reaction (PCR) testing came from hospitals with specialist paediatric services and 69% of PCR tests were from urban facilities around Cape Town
No significant changes in the proportions of specialist hospital and urban PCR testing were observed over the study period; infants tested at specialist hospitals were much more likely to be PCR positive (p,0.001)

Summary

Introduction

Infant diagnosis (EID) of HIV infection is an important service to reduce paediatric morbidity and mortality related to HIV/AIDS. EID is an important component of effective PMTCT programmes, HIV PCR testing is relatively expensive, requires specialised laboratory equipment, and is time consuming. This means the testing components of EID is firmly in the domain of centralised specialist laboratories. This in turn makes health systems issues and logistical considerations, such as conducting HIV testing in primary care facilities, transporting specimens to central reference laboratories, and return of results to primary care, a major concern [7,8]

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