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Description : HIV TESTING AT BIRTH – UPDATE FROM SOUTH AFRICA

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Published on : Jul 16, 2020 | Views : 2030 | Downloads : 0

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TESTING AT BIRTH – UPDATE FROM SOUTH AFRICA Gayle Sherman Centre For HIV and STI, National Institute for Communicable Diseases Department of Paediatrics and Child Health, University of the Witwatersrand 8th International Workshop on HIV Pediatrics 15 July 2016
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CONTENTS Rationale for birth testing in South Africa Anticipated implementation challenges One year Results (June 2015 – May 2016) Birth testing coverage In utero transmission rate Next Steps 2
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Rationale for Birth Testing Testing at 6 weeks too late to prevent morbidity, mortality and loss to follow up in ±20% of perinatally infected infants High PMTCT coverage: in utero > intrapartum transmission (IU:IP = ± 3:1) Captive population of HIV-exposed neonates >90% deliveries in maternity unit maternal HIV testing at delivery identifies virtually all HIV-exposed neonates for testing 3
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Anticipated Challenges Reverse gains of 6-week EID program 2nd HIV PCR required to detect IP infections (10 weeks) Training - HIV PCR into new location & staff Testing & result receipt in 2 different facilities: new models for linkage to care 4
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National Birth testing coverage 5
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54% 60% 78% 88% 75% 66% 81% 59% 53% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga North West Northern Cape Western Cape % Coverage South Africa 73% 6 Provincial Birth testing Coverage
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In utero transmission rates 1,3% 1,1% 1,4% 1,4% 1,2% 1,0% 1,0% 0,9% 1,0% 1,2% 1,1% 1,2% 0,0% 0,2% 0,4% 0,6% 0,8% 1,0% 1,2% 1,4% 1,6% 0 5000 10000 15000 20000 25000 Jun-15 Jul-15 Aug-15 Sep-15 Feb-16 Mar-16 Apr-16 May-16 % PCR posi ve No. of HIV PCR tests Na onal HIV PCR tes ng (Jun 2015-May 2016) Oct-15 Nov-15 <7 days Total PCR Dec-15 Jan-16 <7 days % Posi vity South Africa: in utero transmission rate 1.1% ± 200 HIV-infected neonates per month nationally 7
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In utero & ‘10-week’ transmission rates 1,3% 1,1% 1,4% 1,4% 1,2% 1,0% 1,0% 0,9% 1,0% 1,2% 1,1% 1,2% 2,5% 2,4% 2,5% 2,5% 2,6% 2,1% 1,9% 2,1% 2,5% 2,4% 2,3% 0,0% 0,5% 1,0% 1,5% 2,0% 2,5% 3,0% 0 5000 10000 15000 20000 25000 Jun-15 Jul-15 Aug-15 Sep-15 May-16 % PCR posi ve No. of HIV PCR tests Na onal HIV PCR tes ng (Jun 2015-May 2016) 2,8% <7 days Total PCR Oct-15 Nov-15 7days -< 3 months Total PCR Dec-15 Jan-16 <7 days % Posi vity Feb-16 Mar-16 Apr-16 7days-<3months % Posi vity 8
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In utero & ‘10-week’ transmission rates 1,3% 1,1% 1,4% 1,4% 1,2% 1,0% 1,0% 0,9% 1,0% 1,2% 1,1% 1,2% 2,5% 2,4% 2,5% 2,5% 2,6% 2,1% 1,9% 2,1% 2,5% 2,4% 2,3% 1,6% 1,5% 1,6% 1,8% 1,6% 1,6% 1,3% 1,2% 1,3% 1,6% 1,5% 1,4% 0,0% 0,5% 1,0% 1,5% 2,0% 2,5% 3,0% 0 5000 10000 15000 20000 25000 Oct-15 % PCR posi ve No. of HIV PCR tests Na onal HIV PCR tes ng (Jun 2015-May 2016) 2,8% Jun-15 Jul-15 <7 days Total PCR Aug-15 Sep-15 7days -< 3 months Total PCR Nov-15 Dec-15 <7 days % Posi vity Jan-16 Feb-16 7days-<3months % Posi vity Mar-16 Apr-16 May-16 7days-<3months actual % Posi vity 9
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10 HIV-infected neonates in S.A. Jun 2015 – May 2016 Graphics: N.Ndlovu, Health Systems Trust
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Link every HIV+ neonate to care & assess outcomes Training & mentorship Improve rates of later testing (10 wks-18 mo) Neonatal treatment is complex Longitudinal surveillance to enumerate HIV-infected e.g. unique identifiers and patient linking algorithms monitor guideline implementation e.g. confirmatory testing Monitor linkage to and outcomes of care Evaluate EID POC testing at birth 11 NEXT STEPS
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12 Faith Moyo Ahmad Haeri Mazanderani Sue Candy & NHLS CDW Team Mark Goosen Deirdre Greyling Karl Technau Sergio Carmona Sanjana Bhardwaj ACKNOWLEDGEMENTS

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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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