899b 
Universal HIV Testing of Infants at Immunization Clinics in High HIV Prevalence Settings: Acceptable, Feasible, and Potential for High Returns
Nigel Rollins*1,2, S Mzolo1, T Moodley3, T Esterhuizen4, and H van Rooyen5
1Univ of KwaZulu-Natal, Durban, South Africa; 2WHO, Geneva, Switzerland; 3Futuristic Training Solutions, Durban, South Africa; 4Univ of KwaZulu-Natal, Coll of Hlth Sci, Durban, South Africa; and 5Child, Youth, Family and Social Devt, Human Sci Res Council, Durban, South Africa
Background: Most HIV-infected children in Africa present with severe symptoms and die before they have the chance to start ART, or
even cotrimoxazole prophylaxis. Recent changes to WHO guidelines for the
treatment of HIV-infected children are founded on evidence that early
initiation of antiretroviral therapy significantly improves survival. It is
difficult however, to reconcile this recommendation with the experience
reported by many prevention of mother-to-child transmission of HIV (PMTCT)
programs that postnatal HIV testing of infants is relatively uncommon and early
identification of infected children is difficult.
Methods: Routine HIV testing of infants was offered
to all mothers bringing infants for immunizations at 3 clinics in KwaZulu
Natal. Blood samples were collected by heel prick onto filter paper. Dried
blood spots were tested for HIV antibodies and if present, were tested for HIV
DNA by PCR. Exit interviews were requested of all mothers irrespective of
whether they had agreed to infant testing or not.
Results: Of 646 mothers bringing infants for
immunizations, 584 (90.4%) agreed to HIV testing of their infant and 332
(56.8%) subsequently returned for results. Of 646mothers and infants, 332
(51.4%) thereby had their HIV status confirmed or reaffirmed by the time the
infant was 3 months of age. Overall, 247 of 584 (42.3%) infant dried blood spot
samples had HIV antibodies indicating maternal HIV status. Of these, 54 (21.9%)
samples were positive for HIV DNA by PCR. This equates to 9.2% (54/584) of all
infants tested. The majority of mothers interviewed said they were comfortable
with testing of their infant at immunization clinics and would recommend it to
others.
Conclusions: Screening of all infants at
immunization clinics is acceptable and feasible as a means for early
identification of HIV-infected infants and referral for antiretroviral therapy.
Implications for primary health care systems and related services such as
confidentiality of results and counseling on infant feeding need to be considered
before implementing.
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