An estimated 800,000 children under the age of 15 worldwide remain undiagnosed with HIV. This limits their access to life-saving antiretroviral therapy (ART).
To bridge this gap, the Centre for Infectious Disease Research in Zambia (CIDRZ) undertook a research study titled: Point of Care HIV-1 Diagnosis to Improve Rates of ART Initiation among Infants aimed to estimate the effects of their novel point-of-care early infant diagnosis (POC EID) community model on EID testing positivity, HIV-positive infant case finding, and ART linkage, initiation, and 3-month retention among HIV-infected infants and young children.
Between June 1, 2019, and May 31, 2020, six health facilities in Lusaka enrolled mother-infant pairs (MIPs) at high risk of vertical HIV transmission. High-risk MIPs were identified based on late or missing infant EID testing and other maternal risk factors and offered community POC EID testing. Their outcomes were compared to historical high-risk controls at the same facilities from June 1, 2017, to May 31, 2018. The study applied propensity score matched weighting and mixed-effects regression modeling to analyze differences in HIV positivity, ART initiation, and early retention in care. A total of 2,577 MIPs were included in the analysis.
Infant HIV positivity was significantly higher in the post-intervention group at 2.2% compared to the pre-intervention group at 1.1% (p=0.038). MIPs where the mother had disengaged from care were 12.97 times more likely to have an infant diagnosed with HIV than those where the infant received late EID testing, but the mother remained in care (95% CI: 2.41, 69.98). Among 18 infants diagnosed with HIV through the intervention, 16 (88.9%) initiated same-day ART. All continued treatment at the three-month follow-up. This study demonstrates that community-based differentiated care using POC EID technology can enhance HIV case identification among high-risk infants and young children. It facilitates high rates of same-day ART initiation and early retention in care. These findings suggest that such community-based interventions could be a valuable complement to traditional facility-based HIV testing approaches. This ensures that more infants and young children living with HIV receive timely diagnosis and treatment.