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DOES HIV-PCR TESTING OF HIV-EXPOSED INFANTS AT BIRTH REDUCE FOLLOW-UP FOR TESTING AT 4 -14 WEEKS OF AGE? PowerPoint Presentation

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Description : DOES HIV-PCR TESTING OF HIV-EXPOSED INFANTS AT BIRTH REDUCE FOLLOW-UP FOR TESTING AT 4 -14 WEEKS OF AGE?

Tags : Pediatrics, Child Health, pediatric practice, pediatrician, health providers, HIV-infected infants, Adolescent Transition, HIV-infected adolescents, epidemiology, south Africa, HIV-PCR TESTING

Published on : Jul 16, 2020 | Views : 943 | Downloads : 0

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DOES HIV-PCR TESTING OF HIV-EXPOSED INFANTS AT BIRTH REDUCE FOLLOW-UP FOR TESTING AT 4 -14 WEEKS OF AGE? Emma Kalk, Max Kroon, Andrew Boulle, Meg Osler, Jonathan Euvrard, Kathryn Stinson, Venessa Timmerman & Mary-Ann Davies
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6 weeks 10 weeks Post breast-feeding In utero & intrapartum Post-partum Globally, in 2014 only 50% of infants were tested by 2 months. ART delayed in HIV-infected infants. 6 week time-point is not validated in presence of extended infant drug prophylaxis.
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6 weeks 10 weeks Post breast-feeding In utero & intrapartum Post-partum Detect 75% of infants who will test positive at 6 weeks. Detect infants at high risk of rapid progression. Birth In utero
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BACKGROUND A caveat to HIV testing at birth is that a second PCR will be required to detect late intra-partum and post-natal infections in addition to testing after cessation of breast- feeding. OBJECTIVE To determine whether a negative birth HIV-PCR result decreased follow-up for routine testing at 4-14 weeks.
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METHODS Infants born to a cohort of HIV-infected women Antenatal care at Mitchell’s Plain Midwife Obstetric Unit Delivery: MP MOU and its 3 referral hospitals February 2014 – March 2015 Analysis: logistic regression Outcome: HIV-PCR test result @ 4 – 14 weeks Adjusted for other predictors of routine testing @ 4 – 14 weeks
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METHODS Testing algorithm at the time: Routine HIV-PCR all exposed infants @ 4 – 6 weeks old August 2014: targeted birth HIV-PCR – high-risk criteria HIGH-RISK CRITERIA FOR VERTICAL HIV INFECTION BIRTH PCR INDICATED Maternal ART for less than 3 months before delivery Maternal viral load > 1000 copies/ml or unknown Infant less than 37 weeks completed gestation Birth weight less than 2.5 kg
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ppt slide no 7 content not found
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RESULTS 870 mother-infant pairs 49% ≥ 1 high-risk criterion 18% of these were tested at birth Increasing number of high-risk criteria increased the likelihood of having a birth HIV-PCR 5% if no risk factors 15% if one risk factor 32% if ≥ 2 risk factors
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RESULTS Overall vertical transmission: 1.2% 74% of the cohort had an HIV-PCR at 4 – 14 weeks 3.96% birth HIV-PCR positive versus 0.31% at 4 – 14 weeks
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RESULTS
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birth PCR 19.7% 15% 25.9% 45.2% Timing of HIV testing by high-risk criteria
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RESULTS – logistic regression
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Limitations May not be generalizable outside the Western Cape. Used laboratory data: an HIV-PCR result does not guarantee receipt of result by care-giver. Reason for non-return for routine test may be owing to illness/death. Future: link to admissions and mortality data
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CONCLUSIONS In this South African cohort, half of HIV-exposed infants had at least one high-risk criterion for vertical HIV transmission. The proportion who received a birth HIV-PCR was low (<20%). 74% of exposed infants had an HIV-PCR at 4 – 14 weeks. Nearly 4% of birth HIV-PCRs were positive. Receipt of a negative birth HIV-PCR result was associated with reduced follow-up testing at 4-14 weeks. Strengthened follow-up systems are needed to ensure adequate early infant diagnosis coverage.
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ACKNOWLEDGEMENTS Vumela Mzangwe, Kungeka Ndindwa, Ranga Matima & Jess Barker on the CTG team Marvin Hsiao at the NHLS Staff and patients of MP MOU and referral hospitals Supported by the NICHD: R01 HD075156 (Mary-Ann Davies)

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MarieAltmann

About : I am a passionate Pediatrician with experience of working in world-renowned hospital systems as well as community-based clinics. I have skills like Advocacy, Team Building, Event Planning, and Public Speaking. A dedicated and worthy healthcare services professional with a MPH focused in International studies from Tulane School of Public Health and Tropical Medicine.
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