title: Birth diagnosis of HIV infection in infants to reduce infant mortality and monitor for elimination of mother-to-child transmission.
abstract: BACKGROUND
  Early initiation of antiretroviral therapy depends on an early infant diagnosis and is critical to reduce HIV-related infant mortality. We describe the implementation of a routine prevention of mother-to-child transmission program and focus on early infant diagnosis to identify opportunities to improve outcomes.
  
  
  METHODS
  HIV-exposed infants and their mothers were enrolled in a prospective, observational cohort study at a routine, hospital-based prevention of mother-to-child transmission and HIV treatment service in Johannesburg, South Africa. Infant HIV status was determined by testing samples collected between birth and 6 weeks and searching the national laboratory information system for polymerase chain reaction results of defaulting infants who accessed testing elsewhere.
  
  
  RESULTS
  Of 838 enrolled infants, HIV status was determined for 606 (72.3%) by testing at the study site, 85 (10.1%) by accessing test results from other facilities, 19 (2.3%) by testing stored samples and remained unknown in 128 (15.3%) infants. In total, 38 perinatally HIV-infected infants were identified. Thirty (79%) HIV-infected infants accessed 6-week testing and initiated antiretroviral therapy at a median age of 16.0 weeks, but only 14 were in care a median of 68 weeks later and 4 had died. Eight (21%) HIV-infected infants, 2 of whom died, escaped identification by routine testing. Their mothers were younger, more likely to be foreign and accessed less optimal antenatal care.
  
  
  CONCLUSIONS
  Six-week testing delayed antiretroviral therapy initiation beyond the time of early HIV-related infant mortality and missed one-fifth of perinatally HIV-infected infants. Earlier diagnosis and improved retention in care are required to reduce infant mortality and accurately measure elimination of mother-to-child transmission.
authors.affiliation: From the *Paediatric HIV Diagnostic Syndicate, Wits Health Consortium; †Department of Paediatrics, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand; ‡National Health Laboratory Service; and §Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Rivka R
authors.initials: RR
authors.lastname: Lilian
authors.forename: Emma
authors.initials: E
authors.lastname: Kalk
authors.forename: Karl-Gunter
authors.initials: KG
authors.lastname: Technau
authors.forename: Gayle G
authors.initials: GG
authors.lastname: Sherman
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D019829:Nevirapine / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine