Early infant diagnosis of HIV in India—Early results and sero-positivity determinants

Urvish Joshi, Umesh Oza, Anand Solanki, Sheetal Vyas, Heena Modi

Assistant Professor, Dept of Community Medicine, AMC MET Medical College, Ahmedabad, Gujarat, India.
Monitoring & Evaluation Officer, Ahmedabad Municipal Corporation AIDS Control Society, Ahmedabad, Gujarat, India.
Professor & Head, Dept of Community Medicine, AMC MET Medical College, Ahmedabad, Gujarat, India.
Project Director, Ahmedabad Municipal Corporation AIDS Control Society, Ahmedabad, Gujarat, India.

DOI: 10.4236/ojpm.2012.23046                

Abstract

Introduction: PMTCT under NACP-III cover ex-posed children born to sero-positive mothers. Baby’s sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earlier, with subsequent ART-linkage and 18-months-con- firmation. In Ahmedabad, with 55,000 annual pre- gnancy-HIV-testing, sero-prevalence is 0.27%. Methodology: Entry-points in EID are at 6 weeks, 6 months or 12 months. Cohort of 213 exposed children since EID roll-out (June 2010-December 2011) at all tertiary care hospitals under Ahme-dabad Municipal Corporation was assessed for sero-positivity-prevalence, DBS validity and assessment of baby’s sero-status-determinants. De-identified, secondary data were captured under routine public-health-program. Necessary permissions taken. Results: 144 HIV sero-positive deliveries took place. 213 exposed children were enrolled in EID. Cumulatively, 18 (8.45%) were tested positive at all entry-points. Out of sero-positives confirmed at 18 months, 60% children’s mothers were detected either in second or third trimester. In 40%, mothers remained undiagnosed intra-partum. Mothers were not on ART intra-partum in 80% (RR 1.8). Peri-partum ARV prophylaxis-single-dose-Nevirapine (sdNVP) was not given in 60%. [RR 18, CI 3.69 to 87.70 at 95% (p < 0.0003)]. In 60%, mode of delivery was vaginal, deliveries were handled in emergency. History of exclusive breastfeeding was in 60%. Discussion: Rise in yield of sero-positivity with age, highest proportion of sero-positivity and highest number of entrants at 6 weeks call for efforts targeted towards increasing earliest EID uptake clubbed with immunization visits. Feasibility, validity and early-ART-linkage to reduce mortality are features of DBS. Results justify its use in national program. Earliest pregnancy-HIV detection, HIV-testing for emergency deliveries, intra-partum sdNVP to both mother and baby, ART-linkage of eligible mothers and following infant feeding guidelines remain cornerstone of PMTCT success.

Keywords

PMTCT; Early-Infant-Diagnosis (EID); Dried-Blood-Spot (DBS); HIV Sero-Positivity Determinants; Vertical Transmission

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Sherman, G.G., Stevens, G., Jones, Stephanie, A., Horsfield, P. and Stevens, W.S. (2005) Dried blood spots improve access to HIV diagnosis and care for infants in low-resource settings. Journal of Acquired Immune Deficiency Syndromes, 38, 615-617. doi:10.1097/01.qai.0000143604.71857.5d
[2]	Creek, T.L., Sherman, G.G., Nkengasong, J., Lu, L., Finkbeiner, T., Fowler, M.G., et al. (2007) Infant human immunode-ficiency virus diagnosis in resource-limited settings: Issues, technologies, and country experiences. American Journal of Obstetrics & Gynecology, 197, S64- S71. doi:10.1016/j.ajog.2007.03.002
[3]	Stevens, W., Sher-man, G., Downing, R., Parsons, L.M., Ou, C.Y., Crowley, S., et al. (2008) Role of the laboratory in ensuring global access to ARV treatment for HIV- infected children: Consensus statement on the performance of laboratory assays for early infant diagnosis. Open AIDS Journal, 2, 17-25. doi:10.2174/1874613600802010017
[4]	Jain, K., Mahajan, R., Shevkani, M. and Gupta, P.K. (2011) Early infant diagnosis: A new tool of HIV diagnosis in children. Indian Journal of Community Medicine, 36, 139-142.
[5]	National AIDS Control Organization (2006) Guidelines for HIV care and treatment in infants and children. http://www.nacoonline.org/About_NACO/Policy__Guidelines/Policies__Guidelines_Table_for_download/
[6]	Sentinel Surveillance Report.
[7]	National AIDS Control Organization: Guidelines for the prevention of mother to child transmission of HIV.
[8]	Creek, T. (2008) Early diagnosis of human immunodeficiency virus in infants using polymerase chain reaction on dried blood spots in Botswana’s national program for prevention of mother-to-child transmission. Pediatric Infectious Disease Journal, 27, 22-26. doi:10.1097/INF.0b013e3181469050
[9]	Nuwagaba-Biribonwoha, H., Werq-Semo, B., Abdallah, A., Cunningham, A., Gamaliel, J.G., Mtunga, S., et al. (2010) Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania. BMC Pediatrics, 10, 44. doi:10.1186/1471-2431-10-44
[10]	Pathfinder International/ Kenya’s Prevention of Mother to Child Transmission Project Early Infant Diagnosis of HIV through Dried Blood Spot Testing (2007) Available from: http://www.pathfind.org/site/DocServer/Kenya_EID.pdf?docID=10201