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TESTING AT BIRTH –
UPDATE FROM SOUTH AFRICA
Gayle Sherman
Centre For HIV and STI, National Institute for Communicable Diseases
Department of Paediatrics and Child Health, University of the Witwatersrand
8th International Workshop on HIV Pediatrics
15 July 2016
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CONTENTS
• Rationale for birth testing in South Africa
• Anticipated implementation challenges
• One year Results (June 2015 – May 2016)
oBirth testing coverage
o In utero transmission rate
• Next Steps2
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Rationale for Birth Testing
• Testing at 6 weeks too late to prevent morbidity, mortality and loss to follow up in ±20% of perinatallyinfected infants
• High PMTCT coverage:
– in utero > intrapartum transmission (IU:IP = ± 3:1)
• Captive population of HIV-exposed neonates
– >90% deliveries in maternity unit
– maternal HIV testing at delivery
– identifies virtually all HIV-exposed neonates for testing
3
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Anticipated Challenges
• Reverse gains of 6-week EID program
• 2nd HIV PCR required to detect IP infections (10 weeks)
• Training - HIV PCR into new location & staff
• Testing & result receipt in 2 different facilities: new models for linkage to care
4
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5
National Birth testing coverage
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54%
60%
78%
88%
75%
66%
81%
59%
53%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
EasternCape
FreeState
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
NorthWest
NorthernCape
WesternCape
%Coverage
SouthAfrica73%
Provincial Birth testing Coverage
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In utero transmission rates
1,3%
1,1%
1,4% 1,4%
1,2%
1,0% 1,0%
0,9%
1,0%
1,2%
1,1%
1,2%
0,0%
0,2%
0,4%
0,6%
0,8%
1,0%
1,2%
1,4%
1,6%
0
5000
10000
15000
20000
25000
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16
%PCRposi
ve
No.o
fHIVPCRtests
Na onalHIVPCRtes ng(Jun2015-May2016)
<7daysTotalPCR <7days%Posi vity
South Africa: in utero transmission rate 1.1%± 200 HIV-infected neonates per month nationally
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In utero & ‘10-week’ transmission rates
1,3%
1,1%
1,4% 1,4%
1,2%
1,0% 1,0%0,9%
1,0%
1,2%1,1%
1,2%
2,5%2,4%
2,5%
2,8%
2,5%2,6%
2,1%
1,9%
2,1%
2,5% 2,4%2,3%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
0
5000
10000
15000
20000
25000
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16
%PCRposi
ve
No.o
fHIVPCRtests
Na onalHIVPCRtes ng(Jun2015-May2016)
<7daysTotalPCR 7days-<3monthsTotalPCR <7days%Posi vity 7days-<3months%Posi vity
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In utero & ‘10-week’ transmission rates
1,3%1,1%
1,4%
1,4%
1,2%
1,0% 1,0%0,9%
1,0%
1,2%1,1% 1,2%
2,5%2,4%
2,5%
2,8%
2,5%2,6%
2,1%1,9%
2,1%
2,5%2,4%
2,3%
1,6% 1,5% 1,6%
1,8%
1,6% 1,6%
1,3%1,2%
1,3%
1,6% 1,5% 1,4%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
0
5000
10000
15000
20000
25000
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16
%PCRposi
ve
No.o
fHIVPCRtests
Na onalHIVPCRtes ng(Jun2015-May2016)
<7daysTotalPCR 7days-<3monthsTotalPCR <7days%Posi vity 7days-<3months%Posi vity 7days-<3monthsactual%Posi vity
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HIV-infected neonates in S.A.Jun 2015 – May 2016
Graphics: N.Ndlovu, Health Systems Trust
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• Link every HIV+ neonate to care & assess outcomes
• Training & mentorship– Improve rates of later testing (10 wks-18 mo)
– Neonatal treatment is complex
• Longitudinal surveillance to– enumerate HIV-infected e.g. unique identifiers and
patient linking algorithms
– monitor guideline implementation e.g. confirmatory testing
– Monitor linkage to and outcomes of care
• Evaluate EID POC testing at birth
11
NEXT STEPS
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Faith MoyoAhmad Haeri Mazanderani
Sue Candy & NHLS CDW TeamMark Goosen
Deirdre GreylingKarl Technau
Sergio CarmonaSanjana Bhardwaj
ACKNOWLEDGEMENTS