Early-Infant Diagnosis: Bringing Infants into the HIV Equation

One of the last frontiers in the “no new HIV infections” goal is early infant diagnosis (EID): diagnosing and treating HIV-exposed and -positive infants. EID is urgent in the context of the epidemic: Up to 30 percent of HIV-positive babies will die within 12 months if not treated (EGPAF 2016). Aida Yemaneberhan, Technical Advisor for Prevention of Mother-to-Child Transmission (PMTCT) at AIDSFree, and Sabrina Eagan, Technical Advisor for Adult and Pediatric Treatment at AIDSFree, described the challenges of EID and what AIDSFree is doing to support this critical service.

EID is a complex cascade whose every step must be completed successfully. Complexity begins at the facility itself. EID is not yet a routine service; exposed infants tend to be identified either when they come for other services or when mothers bring them for testing. Once identified, they need to be tested. “And then getting the result is problematic,” Yemaneberhan said. “The sample has to be sent to a lab. It can take weeks to come back. Then, the facility needs to contact the mother for follow-up. Then, those who tested positive must be treated, and negative ones need to be followed up.”

For these steps to take place, providers and facilities must understand the importance of EID, know the protocols for providing the service, and have the drugs and supplies in place to do so. Mothers, too, must understand the importance of EID. They need to return to the clinic with their infant to obtain the test results; if the infant is positive, they must begin antiretroviral therapy. Even if the test result is negative, the mother must know how to keep the infant HIV-free: continuing her own HIV treatment, especially during breastfeeding; and returning for a follow-up test for the child. Adding to the difficulty, Eagan said, is the widespread practice of following mothers and babies separately, rather than in pairs.

Thus, many barriers contribute to low overall uptake of this essential service.”Pregnancy is a very distinct period in the woman’s life, and the baby’s; you’d think we’d have a better system in place,” Eagan said.

Yet AIDSFree’s work has shown that EID programs can be effective in increasing the number of infants tested and linked to care. In Swaziland, AIDSFree mentored providers and developed systems for tracking and contacting clients; as a result, 87 percent of exposed infants were identified and tested, and 85 percent of positive infants were started on treatment. In Tanzania, AIDSFree provided technical assistance to improve HIV services, including PMTCT and EID, in 44 prison and police facilities. Through June 2016, this work supported PMTCT for over 10,000 women and provided antiretroviral therapy for 322 women and EID for 403 infants (92% of those exposed).

AIDSFree and its partners are also exploring point-of-care (POC) testing as a way of accelerating the EID cascade. POC testing could indicate a baby’s HIV status while the mother waits, removing the need for a transport to a lab and a return visit, and enabling a quicker initiation on treatment if needed.

AIDSFree is presently rolling out a mother-baby follow-up strategy to reduce loss to follow-up and ensure that both mother and infant receive timely and appropriate treatment. We’ll blog on the progress of this work and other planned activities in future issues. In the meantime, check out AIDSFree’s resources on expanding PMTCT and protecting exposed infants.

 

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