Abstract:
BACKGROUND: Retention in care is associated with improved virological control and survival among HIV-infected children. However,
retention of children in HIV care remains a challenge.
OBJECTIVES: To describe, using routine laboratory HIV test data, the retention-in-care and virological outcomes of HIV-infected children
aged <18 months in two districts in South Africa.
METHODS: HIV polymerase chain reaction (PCR)-positive results of children from uMkhanyakude and Tshwane districts in KwaZulu-
Natal and Gauteng provinces, respectively, tested between April 2015 and May 2016, were extracted from the National Health Laboratory
Service’s Corporate Data Warehouse (CDW). HIV-related tests (PCR, viral load (VL), CD4+) were documented longitudinally for each child
for ≥13 months after the first positive PCR result by manually searching demographics within the CDW, supplemented by an automated
patient-linking algorithm. Test sets were linked if two or more demographics (surname, name, date of birth, folder number) matched
exactly. Programmatic indicators assessed included age at first positive PCR test, presumed confirmatory test rates, retention in care, and
VL suppression at 6 and 12 months.
RESULTS: Ninety-four and 304 children tested HIV PCR-positive in uMkhanyakude and Tshwane, respectively. The median age at diagnosis
was 3.6 months (interquartile range (IQR) 1.4 - 7.1) for uMkhanyakude and 2.3 months (IQR 0.1 - 6.7) for Tshwane. In uMkhanyakude,
confirmed in utero infections accounted for 18.1% of transmissions (n=17), compared with 29.6% (n=90) in Tshwane. Presumed
confirmatory test rates following an initial positive PCR result were 77.7% and 71.7% for uMkhanyakude and Tshwane, respectively. Within
6 months of starting antiretroviral therapy, 43 children (58.9%) were lost to follow-up in uMkhanyakude compared with 160 (73.4%) in
Tshwane. Of those retained in care at 6 months with a VL measurement, 15 (60.0%) from uMkhanyakude had a VL <1 000 copies/mL,
compared with 24 (48.0%) in Tshwane. For both districts, a third of all HIV PCR-positive children were retained in care at the end of followup,
with 29 (30.9%) in uMkhanyakude and 99 (32.5%) in Tshwane. Of these, 12 (41.4%) had a VL <1 000 copies/mL in uMkhanyakude
compared with 28 (28.3%) in Tshwane.
CONCLUSIONS: We demonstrate the value of routine laboratory data in monitoring diagnosis, retention and VL suppression in HIV-infected
children. This approach is scalable, can be reported near real-time, is relatively inexpensive to implement, and provides a tool for improving
paediatric HIV services until clinical databases can assume this role.
