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Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa.
BMC Infect Dis 2019; 19(Suppl 1):790BI

Abstract

BACKGROUND

Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure.

METHODS

Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed.

RESULTS

Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB. Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no statistically significant differences in baseline characteristics between HIV positive infants who returned for an exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst these HIV positive children < 18 months would be 43.6%.

CONCLUSIONS

Early ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014.

Authors+Show Affiliations

Mamelodi Hospital, Pretoria, 0112, South Africa. Department of Paediatrics, University of Pretoria, Pretoria, 0001, South Africa.Biostistics Unit, South African Medical Research Council, Pretoria, 0001, South Africa.Health Section, United Nations Children's Fund (UNICEF), New York, NY, 10017, USA. School of Public Health, University of the Western Cape, Cape Town, 7535, South Africa.Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.Department of Paediatrics, University of Pretoria, Pretoria, 0001, South Africa.Department of Paediatrics, University of Pretoria, Pretoria, 0001, South Africa. Ameena.Goga@mrc.ac.za. Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001, South Africa. Ameena.Goga@mrc.ac.za. 8 HIV Prevention Research Unit, South African Medical Research Counci, Durban, 3630, South Africa. Ameena.Goga@mrc.ac.za.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31526376

Citation

Mathivha, Elelwani, et al. "Uptake of Care and Treatment Amongst a National Cohort of HIV Positive Infants Diagnosed at Primary Care Level, South Africa." BMC Infectious Diseases, vol. 19, no. Suppl 1, 2019, p. 790.
Mathivha E, Olorunju S, Jackson D, et al. Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa. BMC Infect Dis. 2019;19(Suppl 1):790.
Mathivha, E., Olorunju, S., Jackson, D., Dinh, T. H., du Plessis, N., & Goga, A. (2019). Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa. BMC Infectious Diseases, 19(Suppl 1), p. 790. doi:10.1186/s12879-019-4342-3.
Mathivha E, et al. Uptake of Care and Treatment Amongst a National Cohort of HIV Positive Infants Diagnosed at Primary Care Level, South Africa. BMC Infect Dis. 2019 Sep 16;19(Suppl 1):790. PubMed PMID: 31526376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa. AU - Mathivha,Elelwani, AU - Olorunju,Steve, AU - Jackson,Debra, AU - Dinh,Thu-Ha, AU - du Plessis,Nicolette, AU - Goga,Ameena, Y1 - 2019/09/16/ PY - 2019/9/19/entrez PY - 2019/9/19/pubmed PY - 2019/9/19/medline SP - 790 EP - 790 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 19 IS - Suppl 1 N2 - BACKGROUND: Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure. METHODS: Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed. RESULTS: Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB. Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no statistically significant differences in baseline characteristics between HIV positive infants who returned for an exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst these HIV positive children < 18 months would be 43.6%. CONCLUSIONS: Early ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/31526376/Uptake_of_care_and_treatment_amongst_a_national_cohort_of_HIV_positive_infants_diagnosed_at_primary_care_level,_South_Africa L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4342-3 DB - PRIME DP - Unbound Medicine ER -