Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 14;17(1):e0262518.
doi: 10.1371/journal.pone.0262518. eCollection 2022.

An analysis of the HIV testing cascade of a group of HIV-exposed infants from birth to 18 months in peri-urban Khayelitsha, South Africa

Aurelie Kennedy Nelson  1 , Tali Cassidy  1   2 , Laura Trivino Duran  1 , Vivian Cox  3 , Catherine J Wedderburn  4   5 , Janet Giddy  6 , Pauline Pieters  6 , Mark F Cotton  7 , Tabitha Mutseyekwa  1 , Bulelwa Rorwana  1 , Beryl Sibanda  1 , Jonathan Bernheimer  1 , Nopinky Matise  1 , Petros Isaakidis  8 , Jean Maritz  9   10
Affiliations

An analysis of the HIV testing cascade of a group of HIV-exposed infants from birth to 18 months in peri-urban Khayelitsha, South Africa

Aurelie Kennedy Nelson et al. PLoS One. .

Abstract

Background: Despite the reduction of HIV mother-to-child transmission, there are concerns regarding transmission rate in the breastfeeding period. We describe the routine uptake of 6 or 10 (6/10) weeks, 9 months and 18 months testing, with and without tracing, in a cohort of infants who received HIV PCR testing at birth (birth PCR) (with and without point of care (POC) testing) in a peri-urban primary health care setting in Khayelitsha, South Africa.

Methods: In this cohort study conducted between November 2014 and February 2018, HIV-positive mothers and their HIV-exposed babies were recruited at birth and all babies were tested with birth PCR. Results of routine 6/10 weeks PCR, 9 months and 18 months testing were followed up by a patient tracer. We compared testing at 6/10 weeks with a subgroup from historical cohort who was not tested with birth PCR.

Results: We found that the uptake of 6/10 weeks testing was 77%, compared to 82% with tracing. When including all infants in the cascade and comparing to a historical cohort without birth testing, we found that infants who tested a birth were 22% more likely to have a 6/10 weeks test compared to those not tested at birth. There was no significant difference between the uptake of 6/10 weeks testing after birth PCR POC versus birth PCR testing without POC. Uptake of 9 months and 18 months testing was 39% and 24% respectively. With intense tracing efforts, uptake increased to 45% and 34% respectively.

Conclusion: Uptake of HIV testing for HIV-exposed uninfected infants in the first 18 months of life shows good completion of the 6/10 weeks PCR but suboptimal uptake of HIV testing at 9 months and 18 months, despite tracing efforts. Birth PCR testing did not negatively affect uptake of the 6/10 weeks HIV test compared to no birth PCR testing.

PubMed Disclaimer

Conflict of interest statement

Aurelie Kennedy Nelson, Tali Cassidy, Laura Trivino Duran, Vivian Cox, Catherine J Wedderburn, Tabitha Mutseyekwa, Bulelwa Rorwana, Beryl Sibanda, Jonathan Bernheimer, Nopinky Matise, Petros Isaakidis, were employed by MSF at the time of the study. The authors have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow chart of HIV testing post birth PCR before and after tracing.
†6–12 weeks + within 1 month of tracing; ‡8–10 months+ within 1 month of tracing; §17–19 months+ within 1 month of tracing.
Fig 2
Fig 2. Proportion of HIV-exposed uninfected infants who completed HIV testing at each time point by baseline characteristics (95% confidence intervals).
See this image and copyright information in PMC

References

    1. UNAIDS. Communities at the centre. Defending rights, breaking barriers, reaching people with HIV services. 2019.
    1. World Health Organization. Policy Brief: Consolidated guidelines on the use of antiretroviral therapy and preventing HIV infection. What’s new. WHO Guidel. 2015;(2):20.
    1. Francke JA, Penazzato M, Hou T, Abrams EJ, MacLean RL, Myer L, et al.. Clinical impact and cost-effectiveness of early infant HIV diagnosis in South Africa: Test timing and frequency. J Infect Dis. 2016;214:1319–28. doi: 10.1093/infdis/jiw379 - DOI - PMC - PubMed
    1. Gill MM, Machekano R, Isavwa A, Ahimsibwe A, Oyebanji O, Akintade OL, et al.. The association between HIV status and antenatal care attendance among pregnant women in rural hospitals in Lesotho. J Acquir Immune Defic Syndr. 2015;68(3):e33–8. doi: 10.1097/QAI.0000000000000481 - DOI - PubMed
    1. Essajee S, Vojnov L, Penazzato M, Jani I, Siberry GK, Fiscus SA, et al.. Reducing mortality in HIV-infected infants and achieving the 90-90-90 target through innovative diagnosis approaches. J Int AIDS Soc. 2015;18(Suppl 6):1–5. doi: 10.7448/IAS.18.7.20299 - DOI - PMC - PubMed

Publication types

MeSH terms

Substances