Page 69 - University of Pretoria Research Review 2017

Foreword
Introductory Messages
study measured the long-term effectiveness of programmes that prevent mother-to-child HIV- transmission. These studies enrolled more than 9 000 mother-baby pairs per survey. Dr Nobubelo Ngandu, from the SAMRC, found higher (22.4% vs 20.6%) uptake of early HIV testing, before attending an antenatal clinic, among pregnant women in the poorest (<40%) sub-group compared to pregnant women in the wealthiest (>40%) subgroup. The women in the poorest sub-group also had higher HIV prevalence compared to women in the wealthiest sub-group (43.7% vs 33.9%). These findings highlight inequity in testing uptake and antenatal HIV prevalence in South Africa.
There have been a number of other studies with some of the findings including that adolescent mothers had three times less PMTCT access, compared to older mothers, and a three-fold increase in mother-to-child- HIV-transmission. There were more child deaths but fewer hospitalisations among HIV-exposed infants (HEI), and there were higher chances of pre-term delivery, low birth weight and small-for-gestational-age among HEI infants, compared to infants unexposed
to HIV. HEI with no antiretroviral exposure, or whose mothers initiated HIV treatment post-conception, had almost twice the odds of pre-term delivery, compared with mothers who started HIV treatment pre- conception, but no increased odds for other outcomes.
The research team also sought to measure adherence to maternal HIV treatment and infant prophylaxis. Sixty percent of mother-infant pairs received the recommended three postnatal clinic visits during the first six weeks of life, uptake was significantly higher (63%) among HEI compared to unexposed infants (58%), and less than 65% of mothers adhered to HIV treatment. Less than 75% of the infants received preventive treatment at 18 months post-delivery. This is a shocking finding, given the high prevalence of HIV in South Africa, and the policy and implementation shift to lifelong HIV treatment for pregnant and lactating women.
Very early infant
diagnosis (VEID) of HIV
Nicolette du Plessis, Paediatric HIV Clinic, Steve Biko Academic Hospital
Mother-to-child transmission of HIV (MTCT), also known as vertical transmission of HIV, can occur during pregnancy, labour and delivery, or via breastfeeding. Without preventive measures, MTCT varies from 10- 30% in non-breastfed infants to 25-45% among breastfeeding mother- child pairs. If the mother is infected with HIV, MTCT can be successfully prevented by using combination antiretroviral therapy (cART) both to treat maternal HIV and as post-exposure-prophylaxis for the infant. Using cART in very young infants to prevent MTCT via breastfeeding depends on the early diagnosis of HIV, especially if the HIV status of the mother is unknown.
The very early infant diagnosis (VEID) study, conceptualised by Professor Nicolette du Plessis, Head of the Paediatric HIV Clinic and a member of the Infectious Diseases group, was initiated in June 2014 after Kalafong Hospital became one of only two Department of Health (DoH) sites to roll out universal HIV birth testing. At the end of 2014, after the initial VEID study findings showed that birth testing was feasible and effective, the DoH decided to implement HIV birth testing nationally.
The VEID study group comprises the Medical Research Council (Professor Ameena Goga), the Department of Medical Immunology, Faculty of Health Sciences (Professor Michael Pepper), and
the National Institute for Communicable Diseases (Dr Ahmad HaeriMazanderani). The group works closely with the Early Infant Diagnostic Unit at the University of the Witwatersrand (Professor Gayle Sherman).
The enrolment of infants in the VEID study ended in December 2017. Initial results suggest that targeted birth HIV PCR testing, using risk- scores, is feasible in resource-constrained settings with limited access to laboratory testing. The most significant risk factors predicting HIV infection in newborn infants were detectable maternal HIV viral load (VL), maternal cART duration of <1 month and whether the infant was symptomatic at birth. The VEID study aims to compare growth in relation to birth parameters of HIV-exposed infected and uninfected infants, as well as following the outcomes of birth-infected, early-treated infants.
DEVELOPMENT AND CHANGE
PEOPLE AND CONTEXTS
HEALTH AND WELL-BEING
Communicable Diseases
PLANET AND SUSTAINABILITY
Awards
Lead Researchers
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