A secondary analysis evaluating retention in care among HIV-positive infants diagnosed at birth using centralized laboratory and point-of-care testing in Pretoria, South Africa

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Abstract Background: Birth HIV PCR Point-of-Care (POC) testing can potentially augment the early infant diagnosis (EID) program. Data on the clinical benefits of birth POC testing in South Africa is limited. We compared attrition rates and six-month outcomes of HIV-positive infants diagnosed at birth using POC or laboratory-based testing. Methods: From 2018 to 2019, HIV-exposed infants underwent a birth POC test at Kalafong Provincial Tertiary Hospital in Pretoria, South Africa. They were compared with a historical control born between 2014 and 2016 who received only laboratory-based testing. Both groups received similar care. Variables associated with attrition and the impact thereof, after six-months post HIV diagnosis, were compared. Attrition was defined as patients no longer in care at the end of the study period. Results: Overall, 52 HIV-positive infants were enrolled (POC group, n=23; control group, n=29).Most mother-infant pair (MIP) attrition occurred in the neonatal period post antiretroviral therapy (ART) initiation (30.4% vs. 20.6%, p=0.24); although not statistically significant, recent maternal ART initiation (<3 months) was associated with higher attrition (1.17, 95% CI 0.22-6.22). More POC MIPs were admitted (19 vs. 14, p=0.02), eight MIPs were admitted for ART initiation. Six-month outcomes demonstrated similar retention rates (65.2% vs. 58.5%, p=0.77). Conclusion: Attrition rates of HIV-positive infants post-initiation remain high irrespective of diagnostic method used. Although POC led to earlier engagement with HIV-positive MIPs, this did not translate to improved retention in care. Greater emphasis should be placed on reducing attrition by identifying and remedying any potential antenatal and postnatal risk factors.

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