‘Dramatic improvements’ as point-of-care HIV testing for infants rolls out in Africa
Data from six countries’ public health programmes suggests the introduction of new testing technologies have significantly increased same-day diagnosis for babies born with HIV and sped up treatment.
Results from public health programmes across six African countries shows the introduction of point-of-care HIV testing for infants has increased same-day diagnosis and dramatically reduced the time it takes for babies with HIV on treatment to start treatment.
The evaluation assessed the ‘before and after’ picture following the introduction of point-of-care testing for under-2s in Cameroon, the Democratic Republic of Congo, Ethiopia, Kenya, Senegal and Zimbabwe between 2017 and 2019.
Data from 4,610 tests conducted in health facilities using point-of-care devices, which allows for sample analysis on site, were compared with 2,890 tests sent to centralised laboratories.
Both tests reported HIV prevalence of 4%. The median infant age was 45 days.
Point-of-care testing greatly reduced the waiting time for results, with 72% of caregivers getting the result the same day as testing. In comparison, caregivers waited a median of 35 days for results from centralised laboratories.
At seven days, 80% point-of-care results had been given to caregivers, and 85% by 28 days (the maximum wait time, according to the World Health Organization). By 90 days, 88% had results, compared to 58% with centralised testing.
The time it took from testing to starting antiretroviral treatment (ART) also reduced. It took a median of 1 day with point-of-care testing, compared to 39 days for centralised testing.
The WHO recommends ‘rapid’ ART initiation for infants, defined as within seven days of diagnosis. The study found 57% of infants identified as HIV positive through point-of-care testing began treatment within 7 days, but only 3% had with centralised testing. Within 90 days, this had risen to 74% for point-of-care but only 31% for centralised testing.
Overall, infants identified as HIV positive with point-of-care testing began ART six times faster than infants diagnosed through centralised testing.
The study also compared situations in which caregivers received a same-day HIV diagnosis for their infant via point-of-care testing with situations in which infants had point-of-care testing but caregivers received the HIV diagnosis later. Infants with a same-day diagnosis began ART more than six times faster than those who received their diagnosis on a later day.
It is worth noting that Zimbabwe contributed 79% of testing data, although further analysis found the results were consistent across most countries. The exception is Kenya, where the median time from point-of-care testing to caregivers receiving results was 28 days. This is because, although clinics got the results within five days, caregivers did not return to collect them for several weeks. This highlights the importance of active follow-up to maximise the benefits of point-of-care testing.
The findings provide further evidence that same-day testing and treatment for infants with HIV can be successfully implemented in resource-limited public health facilities. If point-of-care testing continues to be implemented by governments in sub Saharan Africa, the number of infants who die from an AIDS-related illness is likely to reduce.
However, as the study found, only three-quarters of infants identified as HIV positive through point-of-care testing began ART within 90 days, this new technology alone will not be enough to ensure all babies born with HIV access life-saving treatment.