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Point-of-care HIV testing in infants leads to faster ART start
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Point-of-care HIV testing in newborns exposed to the virus quickens diagnosis and ART initiation, researchers said.
Given sufficient resources, point-of-care testing (POCT) could improve linkage to care for infected infants, they wrote in The Lancet HIV.
“POCT is an accurate and useful instrument for birth HIV testing that increases overall result return rates, reduces time to result and enables earlier ART initiation for HIV-infected neonates,” researcher Karl-Günter Technau, MSc, from the department of pediatrics and child health at the Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg, South Africa, and colleagues wrote. “Implementation is challenging and requires careful consideration and innovative approaches, particularly for busy sites in high maternal HIV prevalence settings.”
The researchers conducted a field evaluation in which they compared POCT with laboratory-based testing (LABT) of infants at RMMCH between Oct. 1, 2014, and April 30, 2016.
The study included 3,970 infants. Of those, 1,732 underwent LABT alone, and 2,238 underwent both LABT and POCT. For LABT, blood samples were sent to the national laboratory in Johannesburg, whereas POCT samples were tested in a satellite laboratory at RMMCH.
Of all infants, 57 (1%) tested positive for HIV, 3,906 (98%) tested negative, results for two were indeterminant and five had no results because the samples could not be repeated.
POCT detected all 30 of the HIV cases among infants who underwent both tests, and the remaining 27 were detected in the infants who underwent LABT alone.
Among infants receiving both tests, all positive results and 96% of negative results were returned to the infants’ mothers, compared with 89% and 53%, respectively, for LABT. The median time to result return for POCT was 1 day, compared with 10 days for LABT, the researchers said. In addition, infants diagnosed via POCT started ART at a median of 1 day after birth, compared with 6 days for LABT.
The data indicate that POCT could improve outcomes in infants with HIV, the researchers said, adding that it requires added resources and study.
“Further research is required to assess the benefits of very early ART initiation in infected children to establish whether this specific consequence of POCT warrants the additional resources required to implement birth POCT,” they wrote.
In related a related editorial, Martina Penazzato, MD, PhD, and colleagues at WHO acknowledged POCT’s potential advantages but stressed that clinicians are failing to detect neonatal HIV in other settings.
POCT has the “potential to reduce early mortality and optimize infants’ outcomes,” they wrote. “But what about those infants that fall through the testing net and are not identified until they get sick? They continue to be missed by insufficient HIV testing in malnutrition wards, tuberculosis clinics and general inpatient services. Those children that progress slowly might never be diagnosed unless index testing is in place so that family members of an HIV-infected individual are all screened for HIV.”
Penazzato and colleagues said that health care officials must focus on development of HIV drug regimens for children. However, pediatric care, they added, extends well beyond ART.
“Service delivery platforms that support and enable a comprehensive package of interventions including nutrition, psychosocial support, child development and social protection are also needed,” they wrote. – by Joe Green
Disclosure: The researchers report no relevant financial disclosures.
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