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

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

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

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

5

National Birth testing coverage

6

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

7

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

8

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

9

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

10

HIV-infected neonates in S.A.Jun 2015 – May 2016

Graphics: N.Ndlovu, Health Systems Trust

• 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

12

Faith MoyoAhmad Haeri Mazanderani

Sue Candy & NHLS CDW TeamMark Goosen

Deirdre GreylingKarl Technau

Sergio CarmonaSanjana Bhardwaj

ACKNOWLEDGEMENTS