Christie Michael J, du Plessis Nicolette M
Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
S Afr J Infect Dis. 2024 Mar 30;39(1):589. doi: 10.4102/sajid.v39i1.589. eCollection 2024.
Birth HIV point-of-care (POC) tests curtail analytical testing issues and expedite diagnosis, potentially allowing for earlier mother-infant pair engagement and improved outcomes. Many children are lost post antiretroviral therapy (ART) initiation within the first 6 months of follow-up.
We compared 6-month retention in care, HIV viral load (VL) suppression and mortality among infants diagnosed with HIV at birth, using laboratory-based versus POC HIV PCR testing.
From 2018 to 2019, infants exposed to HIV underwent birth HIV PCR POC testing at Kalafong Provincial Tertiary Hospital in Tshwane District. Their outcomes were compared to a historical control born between 2014 and 2016, who exclusively underwent laboratory-based HIV PCR testing. Both groups received comparable HIV care following national guidelines.
Fifty-seven infants were studied (POC: 27; Control: 30). The POC turnaround time was significantly shorter (POC: 15.5 h [IQR: 4.3-24.7], Control: 68.3 h [IQR 46.0-93.9]; = < 0.0001). Both populations had the same elapsed time from HIV diagnosis to ART initiation (median: 13 days, POC: IQR 8-21 days; Control: IQR 9-36 days). Six infants were never initiated (POC: 2 [7%]; Control: 4 [13%]). At 6 months, overall care retention was 72% (41/57), higher among the Control group (Control 23/30, 77%; POC: 18/27, 67%). HIV viral suppression at 6 months was higher among the POC group (POC: 14/18, 78%; Control: 9/19, 47%, = 0.09). No deaths were reported.
Poor care retention at 6 months post ART initiation is concerning. Initial mother-infant visits should be effectively utilised to assess and manage potential risk factors for loss of follow-up.
This study highlights the ongoing need to find workable solutions to improve retention in care, thereby ensuring the benefits of expedited HIV diagnosis and ART initiation.
出生时人类免疫缺陷病毒（HIV）即时检测（POC）可减少分析检测问题并加快诊断速度，有可能使母婴更早参与治疗并改善治疗结果。许多儿童在开始抗逆转录病毒治疗（ART）后的随访的前6个月内失访。
我们比较了出生时被诊断为HIV的婴儿中，使用基于实验室的HIV聚合酶链反应（PCR）检测与POC HIV PCR检测的6个月治疗保留率、HIV病毒载量（VL）抑制情况和死亡率。
2018年至2019年，在茨瓦内区卡拉丰省级三级医院对暴露于HIV的婴儿进行出生时HIV PCR POC检测。将他们的治疗结果与2014年至2016年出生的历史对照组进行比较，该对照组仅接受基于实验室的HIV PCR检测。两组均按照国家指南接受了类似的HIV治疗。
共研究了57名婴儿（POC组：27名；对照组：30名）。POC检测周转时间明显更短（POC组：15.5小时[四分位间距：4.3 - 24.7]，对照组：68.3小时[四分位间距46.0 - 93.9]；P < 0.0001）。从HIV诊断到开始ART的时间间隔在两组中相同（中位数：13天，POC组：四分位间距8 - 21天；对照组：四分位间距9 - 36天）。有6名婴儿从未开始治疗（POC组：2名[7%]；对照组：4名[13%]）。在6个月时，总体治疗保留率为72%（41/57），对照组更高（对照组23/30，77%；POC组：18/27，67%）。POC组6个月时的HIV病毒抑制率更高（POC组：14/18，78%；对照组：9/19，47%，P = 0.09）。未报告死亡病例。
ART开始后6个月时治疗保留率低令人担忧。应有效利用最初的母婴就诊来评估和管理失访的潜在风险因素。
本研究强调持续需要找到可行的解决方案以提高治疗保留率，从而确保加快HIV诊断和开始ART的益处。
