Abstract:
BACKGROUND : Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies
recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and
follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information
about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to
understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level,
across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of
HIV-related care. The latter could serve as a marker of knowledge, access or disclosure.
METHODS : Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed
infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV
infected children were identified by total nucleic acid polymerase chain reaction using standardized
procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV
positive infant population, who were treated as a case series in this analysis. Data from interviews
conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive
diagnosis) were analysed.
RESULTS : Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and
1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks,
and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26
years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83%
of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented
recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB.
Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no
statistically significant differences in baseline characteristics between HIV positive infants who returned for an
exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only
two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that
all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst
these HIV positive children < 18 months would be 43.6%.
CONCLUSIONS : Early ART uptake amongst children aged 15 months and below was low. This raises questions
about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care
settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children,
and more work is needed to measure progress with infant ART initiation at primary care level since 2014.
