Abstract:
INTRODUCTION : Maternal viral load monitoring (mVL) and early infant diagnosis (EID) are necessary to achieve elimination of
mother-to-child transmission of HIV. Point-of-care testing can achieve better outcomes compared to centralized laboratory
testing (CLT). We describe the first implementation of point-of-care (POC) mVL and EID testing around delivery at four high
volume tertiary obstetric units (TOUs) in Gauteng, South Africa.
METHODS : Prospective study of pregnant women living with HIV (WLHIV) and their infants. During the period 1 June 2018 to
31 March 2019, routine staff collected blood specimens from women and their infants around delivery. Specimen collection
occurred throughout the week while dedicated POC operators, conducted testing during working hours on weekdays. Descriptive
statistics and multivariable Poisson regression with robust error variance were used to describe outcomes and associated
factors. Outcomes determined were (i) coverage of mVL and EID testing defined as a proportion of live births to WLHIV
admitted at each facility (ii) results returned prior to discharge (iii) turn-around time (TAT) and iv) performance of POC testing
compared to CLT.
RESULTS : In total, 8147 live births to pregnant WLHIV were recorded in the implementation period. Of these, 2912 mVL and
5074 EID specimens were included in the analysis, with 131 (4.5%) mVL and 715 (14.1%) EID specimens having initial invalid/
error results. Overall coverage of POC mVL and EID testing was 35.6% (range 20.9% to 60.1%) and 61.9% (range 47.0% to
88.0%) respectively. Proportions of POC tested mothers and infants with results returned prior to discharge were 74.3%
(range 39.0% to 95.7%) and 73.0% (range 50.0 to 97.9%). Return of results was independently associated with TOU, afterhours
specimen collection, having an initial invalid or error result and period of implementation. Overall TAT for specimens collected
from mother-infant pairs where both had POC testing, during weekdays was longer for EID compared to mVL testing
(median 3.3 hours vs. 2.9 hours, p-value sign test <0.001). POC results were comparable to those from laboratory testing.
CONCLUSION : Accurate and timely POC mVL and EID testing around delivery was implemented with variable success across
TOUs. Further scale up would need to address health system factors at facility level and high analytical error rates.
