Routine infant HIV testing acceptable and feasible at South African immunisation clinics

Routine HIV testing at infant immunisation clinics is feasible and acceptable, investigators from South Africa report in the online edition of AIDS. They found that most mothers agreed to HIV testing and that 7% of the infants of mothers who reported that they were HIV-negative were, in fact, infected with HIV.

Testing at the immunisation clinics allowed both the mothers and infants to be linked into antiretroviral treatment programmes.

Early initiation of HIV treatment in HIV-infected babies is associated with a significantly reduced risk of early death. World Health Organization guidelines therefore recommend that all babies with HIV should start antiretroviral therapy.

However, many infants are unable to benefit from HIV treatment because their infection remains undiagnosed.

To try and increase the detection of HIV infection in babies, investigators in the South African KwaZulu Natal, where 39% of women receiving antenatal care are HIV-positive, undertook a study to see how feasible and acceptable opt-out HIV testing was at infant immunisation clinics.

The study was conducted between November 2007 and February 2008. Mothers attending with infants aged six, ten and 14 weeks were offered opt-out tests by trained counsellors.

Infants and mothers found to be HIV-positive were referred to an antiretroviral treatment clinic.

A total of 646 mothers of infants attending the immunisation clinics were offered opt-out HIV tests by the counsellors. The median age of the infants was a little under eight weeks. Most (584, 90%) mothers consented to their baby being tested for HIV.

There was a very high level of HIV testing amongst the mothers, with 98% reporting that they had ever had a test. The use of single-dose nevirapine during labour was reported by 266 women, although only 233 reported that they were HIV-positive. Of the mothers who said that they were HIV-positive, approximately 70% said their infants received single-dose nevirapine.

Of the 584 mothers who agreed to have their infant tested for HIV, only 332 (57%) returned for the result. Of those who returned, 160 (48%) came back for their scheduled appointment, but approximately 80% of the other women returned within four weeks, often on the date of the next immunisation.

Mothers who reported being HIV-positive were more likely to return than mothers who believed themselves to be HIV-negative.

HIV infection was diagnosed in 247 (42%) of infants, a finding that accorded with the 38% rate of vertical HIV transmission in the province.

Amongst the women who reported being HIV-negative, 7% of their babies were found to be infected with HIV.

Most mothers (78%) said reported that they were comfortable with the offer of an opt-out HIV test for their baby. However, 5% of mothers said that the offer frightened them, and 2% said that it caused anxiety.

Furthermore, 2% of mothers said that they did not accept the offer of an HIV test because they needed more time to decide.

The main reasons for accepting a test were to confirm the HIV status of the infant (77%) and to access to antiretroviral therapy (55%). Over a quarter of women also said that the test result would help inform their infant feeding practices.

“Routine HIV testing of infants attending primary healthcare clinics for immunizations was acceptable and feasible”, write the investigators, “if implemented as the standard of care at primary health care clinics, more than half of infants and mothers would know their HIV status at about 6-10 weeks of age after which they could gain access to a continuum of care.”