Retention in care of infants diagnosed with HIV at birth: Beyond the diagnostic strategy

TL;DR

This study compares infant HIV care outcomes using rapid point-of-care testing versus traditional lab testing, finding similar retention but better viral suppression with the faster method.

Contribution

The study provides new evidence on the impact of point-of-care testing on infant HIV care retention and viral suppression.

Findings

Point-of-care testing significantly reduced diagnostic turnaround time compared to laboratory-based testing.

The POC group showed higher rates of HIV viral suppression at 6 months, though not statistically significant.

Care retention at 6 months was slightly higher in the historical control group, but overall retention remained a concern.

Abstract

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.

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.

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.

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.

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.

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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