Targeted HIV testing at birth supported by low and predictable mother-to-child transmission risk in Botswana

Introduction: Most African countries perform infant HIV testing at 6 weeks or later. The addition of targeted testing at birth may improve retention in care, treatment outcomes and survival for HIV-infected infants. Methods: HIV-exposed infants were screened as part of the Early Infant Treatment (EIT) study in Botswana. Screened infants were [greater than or equal to]35 weeks gestational age and [greater than or equal to]2000 g at birth. Risk factors for mother-to-child transmission (MTCT) were assessed by maternal obstetric card or verbally. Risk factors included 400 copies/mL, poor maternal ART adherence, lack of maternal zidovudine (ZDV) in labour, or lack of infant post-exposure prophylaxis. Infants underwent dried blood spot testing by Roche Cobas Ampliprep/Cobas Taqman HIV-1 qualitative PCR. Results: From April2015 to April2016, 2303 HIV-exposed infants were tested for HIV in the EIT study. Of these, 369 (16%) were identified as high risk for HIV infection by information available at birth, and 12 (0.5% overall, 3.25% of high risk) were identified as HIV positive at birth. All 12 positive infants were identified as high risk at the time of screening, and only 2 risk factors were required to identify all positive infants: either Conclusions: In utero MTCT occurred only among infants identified as high risk at delivery, using information available from the mother or obstetric record. Birth testing that targets high-risk infants based on maternal ART receipt is likely to identify the majority of in utero HIV transmissions, and allows early ART initiation for these infants. Keywords: HIV; mother-to-child transmission; children; paediatrics; vertical transmission; viral suppression
1 | INTRODUCTION The World Health Organization (WHO) recommends HIV testing for all HIV-exposed infants at 4 to 6 weeks of age [1], based on studies demonstrating the benefits of [...]