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Impact of birth HIV PCR testing on uptake of follow-up EID services for HIV-exposed infants in Cape Town PowerPoint Presentation

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Description : Impact of birth HIV PCR testing on uptake of follow-up EID services for HIV-exposed infants in Cape Town

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 : 1491 | Downloads : 0

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Slide 1-

Impact of birth HIV PCR testing on uptake of follow-up EID services for HIV-exposed infants in Cape Town Lorna Dunning1, Max Kroon2, Lezanne Fourie2, Andrea Ciaranello3, Landon Myer1 1Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa 2Department of Neonatal Medicine, University of Cape Town, South Africa 3 Division of Infectious Disease, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA Pediatric HIV Workshop 2016
Slide 2-

Background – Early Infant Diagnosis WHO recommends all HIV-exposed infants should be tested by six weeks of age Virological tests Detect in utero, intra-partum and very early post-partum infections* 94% of HIV-exposed infants have access to a virologic test in South Africa1 * Debate around effect of infant prophylaxis on the sensitivity of the assay at 6 weeks 1 World Health Organization. Progress report on the global plan towards the elimination of new HIV infections among children and keeping their mothers alive. Geneva, Switzerland2015
Slide 3-

Background – 6 week EID Cascade Infant born HIV- exposed 6 weeks- Offer HIV testing Specimen Processing Result Return HIV-infected Infant Link to care - ART HIV-uninfected Exposed Infant Repeat testing after weening Peak age of mortality 11 weeks for HIV-infected infants
Slide 4-

Background – Birth Testing Improved PMTCT coverage Increased proportion of in utero infections relative to intrapartum and early post partum More infected infants detectable at birth Benefits earlier treatment Limit disease progression Lower viral reservoirs Increase survival1 1 Francke et al. Clinical impact and cost effectiveness of early infant HIV diagnosis in South Africa: Test timing and frequency. Pre- publication JID
Slide 5-

Background – Birth Testing Cascade Birth- HIV PCR testing Specimen Processing Result Return Birth Testing HIV- exposed Infant Infant born HIV- exposed 6 week- HIV PCR testing Specimen Processing Result Return HIV-infected Infa Link to care - AR nt T Repeat te wee HIV-infected – Linked to Care Returning a negative result to women immediately after delivery could cause confusion around the need for testing at 6 weeks Recent observational study – only 49% of infants returned for follow up testing after an initial test at birth1 1 J Matritz et al. Low Uptake of Routine Infant Diagnostic Testing Following HIV PCR Testing at Birth. Poster Presentation. CROI 2016
Slide 6-

Objectives To compare the attendance at follow-up EID testing by receipt of an HIV PCR test at birth - Does receipt of a negative birth test impact uptake of 6 weeks testing? Examine yield of targeted birth testing in this setting
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Site Characteristics Secondary level - Obstetric Hospital Women referred from primary care 13% of newborn HIV-exposed Cohort Characteristics July 2013 – August 2015 All mothers eligible for Option B+ HIV PCR test at birth – Infants high risk for perinatal transmission Birth tests occurred within 48hrs of delivery: result return prior to discharge All HIV exposed infants tested at 6 weeks, or screened if presenting to hospital with OI Methods – Site and Cohort Characteristics
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Methods – Study Sample HIV-exposed  High Risk (576) HIV PCR test at Birth Equivocal (3) HIV+ (22) HIV-exposed (551) HIV-exposed (551) HIV-exposed  Low risk Mode of Delivery & Date of Birth HIV PCR test 6 weeks + ? ?
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Results of HIV PCR tests were determined from NHLS database Non-attendance at follow up testing: no subsequent HIV PCR test recorded since birth test or no recorded HIV PCR test Linkage to care: Infect infant specimen sent to laboratory for processing Participant demographic characteristics Mean/median, frequency Logistic regression models OR with 95% confidence intervals Analysis
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15% Results – HIV-exposed infants receiving an HIV PCR test at Birth 55%% 111555%%% 66%% 3338883%%%8% 1155%% 1% 15% 1141114%444%%%% 66%66%%% 5%5% 4% 4444%%%% 4444%%%%3% 3%1% 1%111%%% 111%%% 22%2%% 1% 2% 3%33%% No Reason ART <12 weeks Low Birthweight / Preterm High Viral Load Default from Treatment Unbooked No ART during Pregnancy Seroconverted during Pregnancy Maternal Infection 2nd Line Treatment Substance Abuse Other
Slide 11-

Results – HIV PCR test at birth HIV-exposed  High Risk (576) HIV PCR test at Birth Equivoca l (3) HIV+ (22) HIV-exposed (551) 3.8% of birth tests positive (n=22) 95% confirmatory test 1 false positive result 71% linked to care w/in 3mths 86% linked to care w/in 6mths
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HIV-exposed received birth test (551) HIV-exposed No Birth Test (551) HIV PCR test 6 weeks + Results – HIV PCR test at 6 weeks 0.4% of 6wk PCR tests positive (n=4) 100% confirmatory test 75% linked to care w/in 3mths 100% linked to care w/in 6mths
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Results – Follow up EID test results
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Results – Demographics
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Results – Regression Analysis Univariate Model Crude OR 9 5% CI - 2.17 ( - 1.61-2.93) - - 0.92 ( 0.69-1.23) 1.00 ( - - 0.79 ( 0.99-1.00) 0.56-1.12) 1.01 ( - - 0.86 ( 0.98-1.03) 0.62-1.21) 1.00 ( - - 0.93 ( 0.95-1.07) 0.64-1.35) - - 0.69 ( 0.37 ( 0.43-1.09) 0.06-2.25) - - 2.03 ( 3.24 ( 1.44-2.86) 1.85-5.66) - - 0.94 ( 0.52-1.69) - - 1.42 ( 0.85-2.37)
Slide 16-

Results – Subgroup analyses 10 Adjusted Odds Ratio Restricted analyses showing effect size in multiple subpopulations: Association between non-attendance at follow-up EID testing for infants who received a birth test compared to those that did not 1 0.1 All LBW Norm Mother BW <24yrs Pre- term Full term Mother Black Other >24yrs African
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Limitations Results reflect a single urban setting within South Africa. All participants delivered at an obstetric hospital Generalizations should be made with caution Social and demographic variables would provide greater insight into predictors for non-attendance Risk factors used to identify infants as high risk at delivery could also be predictors for non-attendance
Slide 18-

Conclusions Targeted birth testing successfully identified mothers at high risk for transmission to their infants Neonates undergoing HIV testing at birth appear less likely to receive subsequent EID testing compared to infants who did not receive a birth test. More emphasis on negative results How does universal birth testing affect these results?
Slide 19-

Acknowledgements Research supported by the Elizabeth Glaser Pediatric AIDS Foundation Leigh Anne van Balla & Alex Paone for their contribution during data collection, along with all the staff at MMH.

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