Abstract:
BACKGROUND : In June 2015, South Africa introduced early infant HIV diagnosis (EID) at birth and ten weeks
postpartum. Guidelines recommended return of birth results within a week and ten weeks postpartum results
within four weeks. Task shifting was also suggested to increase service coverage. This study aimed to understand
factors affecting return of EID results to caregivers.
METHODS : Secondary analysis of data gathered from 571 public-sector primary health care facilities (PHCs) during a
nationally representative situational assessment, was conducted. The assessment was performed one to three
months prior to facility involvement in the 2010 evaluation of the South African programme to prevent mother-tochild
HIV transmission (SAPMTCTE). Self-reported infrastructural and human resource EID-related data were collected
from managers and designated staff using a structured questionnaire. The main outcome variable was ‘EID turnaround-
time (TAT) to caregiver’ (caregiver TAT), measured as reported number of weeks from infant blood draw to
caregiver receipt of results. This was dichotomized as either short (≤3 weeks) or delayed (> 3 weeks) caregiver TAT.
Logit-based risk difference analysis was used to assess factors associated with short caregiver TAT. Analysis included
TAT to facility (facility TAT), defined as reported number of weeks from infant blood draw to facility receipt of
results.
RESULTS : Overall, 26.3% of the 571 PHCs reported short caregiver TAT. In adjusted analyses, short caregiver TAT was
less achieved when facility TAT was > 7 days (versus ≤7 days) (adjusted risk difference (aRD): − 0.2 (95% confidence
interval − 0.3-(− 0.1)), p = 0.006 for 8–14 days and − 0.3 (− 0.5-(− 0.1)), p = 0.006 for > 14 days), and in facilities with
staff nurses (compared to those without) (aRD: − 9.4 (− 16.6-(− 2.2), p = 0.011).
CONCLUSION : Although short caregiver TAT for EID was only reported in approximately 26% of facilities, these
facilities demonstrate that achieving EID TAT of ≤3 weeks is possible, making timely ART initiation within 3 weeks of
diagnosis feasible within the public health sector. Our adjusted analyses underpin the need for quick return of results to facilities. They also raise questions around staff mentoring: we hypothesise that facilities with staff nurses
were likely to have fewer professional nurses, and thus inadequate senior support.
