Vertical transmission of HIV among pregnant women who initially had false–negative rapid HIV tests in four South African antenatal clinics

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dc.contributor.author MayaphiI, Simnikiwe H.
dc.contributor.author Martin, Desmond J.
dc.contributor.author Quinn, Thomas C.
dc.contributor.author Stoltz, Anton Carel
dc.date.accessioned 2020-05-13T15:17:59Z
dc.date.available 2020-05-13T15:17:59Z
dc.date.issued 2019-12-20
dc.description S1 Table. Characteristics of participants diagnosed with early or chronic HIV infection. Initial tests were performed from samples obtained at enrolment (i.e. after a negative rapid HIV test result). HIV viral load (VL) tests were performed first to screen for HIV infection, and all the serology tests were performed later. Follow-up (F/U) VL was only performed for participants who had an initial VL <5000 copies/ml [16]. Pt ID = participant’s study identity, F = female, gen = generation, ELISA = enzyme-linked immunosorbent assay, W. Blot = Western Blot, LAg = limiting antigen, Insuf = insufficient, LT = long term (chronic) infection, --- = not available (participant did not return for follow-up), + = positive,— = negative. Units: HIV VL = copies/ml; p24 antigen = cut-off index (COI); Genscreen ELISA = sample cut-off (S/CO); LAg avidity = normalized optical density (OD-n); LAg avidity <1.5 OD-n = early infection; LAg avidity >1.5 OD-n = LT (chronic) infection. ¥ = participant 6738 was previously misclassified as having chronic infection [16], but testing on her follow-up sample revealed low avidity antibodies consistent with early infection; this was confirmed on repeat testing of 6738 sample. P24 antigen, W. Blot and F/U LAg were not performed for the last participants identified with newly diagnosed HIV infection owing to cost limitations. This also applies to the F/U VL for participant 1692, as this was supposed to have been performed according to the diagnostic study protocol [14]. en_ZA
dc.description.abstract INTRODUCTION : There is a risk of mother-to-child transmission of HIV (MTCT) during pregnancy and breastfeeding. The aim of this study was to assess vertical transmission of HIV among pregnant women who initially had false–negative rapid HIV tests in South African antenatal care (ANC) clinics. METHODS : Pregnant participants were enrolled in a diagnostic study that used nucleic acid amplification testing (NAAT) to screen for early HIV infection among individuals who tested negative on rapid HIV tests used at the point-of-care (POC) facilities. Participants were enrolled from four ANC clinics in the Tshwane district of South Africa. All NAAT-positive participants were recalled to the clinics for further management. Vertical transmission was assessed among exposed infants whose HIV polymerase chain reaction (PCR) results were available. RESULTS : This study enrolled 8208 pregnant participants who tested negative on rapid HIV tests between 2013 and 2016. Their median age was 26 years (interquartile range [IQR]: 23–30). NAAT detected HIV infections in 0.6% (n = 49; 95% confidence interval {CI}: 0.5–0.8) of all study participants. The distribution of these infections among the four clinics ranged from 0.3%– 1.1%, but this was not statistically significant (p = 0.07). Forty-seven participants (95.9%) were successfully recalled and referred for antiretroviral treatment initiation as part of prevention of MTCT (PMTCT). Most women with newly diagnosed HIV infection presented for the first ANC visit in the second (61.9%, n = 26) and third (31.0%, n = 13) trimesters. HIV PCR results were available for thirty-two infants, three of whom tested positive (9.4%; 95% CI: 1.98–25.02). CONCLUSIONS : This study showed that supplemental HIV testing for pregnant women led to earlier linkage to the PMTCT programme. Inaccurate diagnosis of HIV infection at ANC clinics is likely to undermine the efforts of eliminating MTCT particularly in HIV-endemic settings. en_ZA
dc.description.department Internal Medicine en_ZA
dc.description.librarian am2020 en_ZA
dc.description.sponsorship This work was supported by SHM - South African Medical Research Council – Self Initiated Research (SA MRC-SIR) grant; SHM - Discovery Foundation grant; SHM - Hamilton Naki Clinical Scholarship; and TCQ - The Division of Intramural Research, NIAID, NIH. en_ZA
dc.description.sponsorship SHM - South African Medical Research Council – Self Initiated Research (SA MRC-SIR) grant; SHM - Discovery Foundation grant; SHM - Hamilton Naki Clinical Scholarship; and TCQ - The Division of Intramural Research, NIAID, NIH. en_ZA
dc.description.uri http://www.plosone.org en_ZA
dc.identifier.citation Mayaphi SH, Martin DJ, Quinn TC, Stoltz AC (2019) Vertical transmission of HIV among pregnant women who initially had false–negative rapid HIV tests in four South African antenatal clinics. PLoS ONE 14(12): e0226391. https://DOI.org/10.1371/journal.pone.0226391. en_ZA
dc.identifier.issn 1932-6203 (online)
dc.identifier.other 10.1371/journal.pone.0226391
dc.identifier.uri http://hdl.handle.net/2263/74573
dc.language.iso en en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights The work is made available under the Creative Commons CC0. en_ZA
dc.subject Risk en_ZA
dc.subject Pregnancy en_ZA
dc.subject Human immunodeficiency virus (HIV) en_ZA
dc.subject Mother-to-child transmission (MTCT) en_ZA
dc.subject Vertical transmission en_ZA
dc.subject Antenatal care (ANC) en_ZA
dc.subject Nucleic acid amplification testing (NAAT) en_ZA
dc.subject Point-of-care (POC) en_ZA
dc.title Vertical transmission of HIV among pregnant women who initially had false–negative rapid HIV tests in four South African antenatal clinics en_ZA
dc.type Article en_ZA


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