16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

HIV PREVALENCE RATES AMONGST 6 WEEK OLD INFANTS IN SOUTH AFRICA: THE CASE FOR UNIVERSAL SCREENING AT IMMUNIZATION CLINICS

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0104

Rollins N.¹, Mzolo S.¹, Little K.², Horwood C.³, Newell M.-L.^4
1 University of KwaZulu-Natal, Department of Paediatrics and Child Health, Durban, South Africa, ² University College, London, International Epidemiology Unit, Institute of Child Health, London, United Kingdom, ³ University of KwaZulu-Natal, Centre for Rural Health, Durban, South Africa, ⁴ Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa

BACKGROUND: Standard PMTCT surveillance methods fail to determine the number of HIV infections being prevented in infants. HIV-infected mothers and infants infrequently gain early access to HIV programmes because of poor identification and referral systems.

METHODS: Routine anonymous, unlinked, HIV prevalence testing was requested of all parents/legal guardians of infants attending 6 week immunisation clinics at 7 primary health care clinics in KwaZulu Natal offering PMTCT services. Dried blood spot (DBS) samples were collected onto filter paper and tested for HIV antibodies (maternal) using a commercial ELISA. DBS samples of infants thereby determined to be HIV-exposed were then tested for HIV RNA by PCR.

RESULTS: DBS samples were collected from 2,439 infants aged 4-8 weeks of age who were brought for their first DTP immunisation. HIV antibodies were identified in 914 (37.6%, CI 35.7 – 39.6%) infants equating to maternal seroprevalence rates; amongst mothers aged 20 – 29 yrs this was 46.9% (CI 42.9% – 50.9%). HIV RNA testing was positive in 189 children of this age (7.6% of all) indicating a vertical transmission rate (VTR) of 20.8% (CI 18.2 – 23.6%). Amongst mothers who indicated they were HIV-infected and had taken single dose nevirapine, VTR was 15.3%. 7.6% women reported having tested HIV-uninfected during the antenatal period but HIV antibodies were identified in the DBS of their infant; 31.2% of these children were infected.

CONCLUSIONS: Screening of all infants at immunisation clinics using this method is an effective and feasible method to monitor the overall impact of PMTCT programmes. In settings where longitudinal follow-up of HIV-infected mother and their children has proven to be difficult universal informed screening of infants at 6 week immunisation visits could serve as an additional opportunity for women to learn their HIV status, identify exposed and infected children early and to increase referrals to the HIV care programmes including ART programmes.

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2006-08-13
ThAc0104

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