Point-of-care infant HIV testing increases rates of confirmatory testing by 55%
Rapid HIV testing at six weeks more than doubles the proportion of HIV-positive newborns getting a confirmatory diagnosis.
Mothers who received their baby’s initial HIV-positive test result on the same day that the test was carried out were 55% more likely to have a confirmatory test carried out, compared to babies who received lab-based testing.
The data comes from an observational analysis of a point-of-care (POC) early infant diagnosis (EID) testing programme in Kenya. The analysis sought to evaluate the effectiveness of POC for improving adherence to Kenya’s HIV testing schedule for HIV-exposed infants.
EID requires an HIV-exposed infant to be tested several times to confirm a diagnosis of HIV. This is because maternal antibodies can still show up in tests taken during the first several months of life, meaning a false-positive result can occur. Re-testing after breastfeeding has stopped is also vital to ensure HIV has not been passed on during this time.
In August 2017, Kenya introduced same-day HIV testing for HIV-exposed infants at six weeks in 33 health facilities in Homa Bay and Turkana. Researchers analysed data from the periods immediately before and after the implementation of POC testing.
According to the new testing schedule, exposed infants receive a POC NAT test at six weeks. If the test comes back positive, infants are immediately started on treatment and have another sample taken for a confirmatory result and one for viral load, which needs to be sent off to a lab. If the infant is negative, they must return at 6 months and 12 months (or when breastfeeding has finished) for follow-up testing.
Before the POC programme was introduced, just 39% of infants who tested HIV positive went on to have a confirmatory test, compared to 94% who received rapid testing – an increase of 55%.
In addition, 84% of infants who initially tested HIV positive went on to have an immediate viral load test, compared to 25% infants in the pre-intervention period.
For HIV-negative infants, 70% had a follow-up test at 6 months and 71% had a follow-up test at 12 months in the pre-intervention period. By comparison, among those receiving rapid tests, 91% had a follow-up test at six months, and 92% had a follow-up test at 12 months. According to an additional analysis, this increase was not statistically significant.
The findings suggest that implementing rapid HIV testing for HIV-exposed newborns has the potential to increase vital confirmatory testing. This not only reduces the risk of infants being wrongly diagnosed with HIV, it also ensures that those infants who are HIV positive can be started on lifesaving treatment immediately.