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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Birth diagnosis of HIV infection in infants to reduce infant mortality and monitor for elimination of mother-to-child transmission
Pediatric Infectious Disease Journal, Volume 32, No. 10, Year 2013
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Description
Background: Early initiation of antiretroviral therapy depends on an early infant diagnosis and is critical to reduce HIV-related infant mortality. We describe the implementation of a routine prevention of mother-to-child transmission program and focus on early infant diagnosis to identify opportunities to improve outcomes. Methods: HIV-exposed infants and their mothers were enrolled in a prospective, observational cohort study at a routine, hospital-based prevention of mother-to-child transmission and HIV treatment service in Johannesburg, South Africa. Infant HIV status was determined by testing samples collected between birth and 6 weeks and searching the national laboratory information system for polymerase chain reaction results of defaulting infants who accessed testing elsewhere. Results: Of 838 enrolled infants, HIV status was determined for 606 (72.3%) by testing at the study site, 85 (10.1%) by accessing test results from other facilities, 19 (2.3%) by testing stored samples and remained unknown in 128 (15.3%) infants. In total, 38 perinatally HIV-infected infants were identified. Thirty (79%) HIV-infected infants accessed 6-week testing and initiated antiretroviral therapy at a median age of 16.0 weeks, but only 14 were in care a median of 68 weeks later and 4 had died. Eight (21%) HIV-infected infants, 2 of whom died, escaped identification by routine testing. Their mothers were younger, more likely to be foreign and accessed less optimal antenatal care. Conclusions: Six-week testing delayed antiretroviral therapy initiation beyond the time of early HIV-related infant mortality and missed one-fifth of perinatally HIV-infected infants. Earlier diagnosis and improved retention in care are required to reduce infant mortality and accurately measure elimination of mother-to-child transmission. Copyright © 2013 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Lilian, Rivka R.
South Africa, Johannesburg
University of the Witwatersrand
Kalk, Emma
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Johannesburg
Rahima Moosa Mother and Child Hospital
Technau, Karl Günter
South Africa, Johannesburg
Rahima Moosa Mother and Child Hospital
Sherman, Gayle Gillian
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Johannesburg
National Health Laboratory Service
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Statistics
Citations: 88
Authors: 4
Affiliations: 4
Identifiers
Doi:
10.1097/INF.0b013e318290622e
ISSN:
08913668
e-ISSN:
15320987
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa