There is poor uptake and follow-up care for infants with perinatally-acquired HIV, according to the results of a secondary analysis published in BMC Infectious Diseases. Using previously gathered data on the 18-month rate of mother-to-child transmission of HIV from a nationally representative cohort of infants aged 6 weeks to 18 months born to mothers with HIV in South Africa, researchers found a substantial need to optimize the primary healthcare system for the care of early pediatric HIV infection, as well as policies that improve the outreach system for such patients and their families.
The study identified a total of 2878 infants who were exposed to HIV perinatally and diagnosed with the infection by age 6 weeks. The investigators analyzed data from maternal interviews conducted at baseline (6 weeks postdelivery) and on study exit (the first visit after a minimum of 3 months after the infant is diagnosed with HIV). All infants born to mothers with confirmed or self-reported HIV were screened for the infection and in accordance with national policy guidelines, these results were returned within 1 month of testing. The results were returned by clinic nurses; per national policy guidelines, all infants and children with confirmed HIV infection are eligible and should be initiated on antiretroviral therapy (ART) within 3 months of diagnosis.
Results demonstrated that 1803 infants who were exposed to HIV were seen for follow-up by age 3 months, whereas 1709, 1673, 1660, 1680, and 1794 at age 6, 9, 12, 15, and 18 months, respectively. A total of 101 infants tested HIV positive and most (76.2%) of the infants who tested positive for HIV were born to single mothers with a mean age of 26.7 years. Though 33.7% of pregnancies were reported as planned, 83% of mothers reported receiving ART drugs to prevent mother-to-child transmission. Of the 44 mothers who knew their CD4 cell count, the median was 346.8 cell/mm3.
Among the infants with HIV, 57.6% of their mothers returned for an exit interview after diagnosis. No statistically significant differences existed in baseline characteristics between infants who were seen for an exit interview and infants who were not. Two infants with HIV whose mothers returned were reportedly receiving triple ART. Investigators concluded that if the assumption is that all children with HIV positivity whose mothers did not return for their exit interview received ART, per protocol, then uptake in infants aged <18 months with HIV would be 43.6%.
In this study, investigators noted that the study cohort was small, and the analysis did not account for survey design, this along with the small percentage of interview returnees limited detailed modeling and may have biased the assessment of ART uptake. Further, data on ART uptake were self-reported and nonuptake could be true or simply not reported. Investigators believed the latter was unlikely, but they were unable to search laboratory databases to ascertain access to ART or viral suppression because infant names were not documented and no identifiers were available to link study number with a laboratory number. The ART uptake status of infants who died is also unknown.
According to investigators, “our results emphasize the need to strengthen primary [healthcare] systems for early pediatric HIV-related care in the first 18 months [postdelivery].”
They further recommended that policy makers integrate healthcare facilities for maternal and child health services and invest in regular systematic community-based tracing of infants and children with HIV. The researchers also highlighted that further research aimed at understanding uptake of pediatric ART and reasons for delayed or poor uptake and adherence is needed.
Mathivha E, Olorunju S, Jackson D, Dinh TH, du Plessis N, Goga A. Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa. BMC Infect Dis. 2019;19:790.