Article

HIV/AIDS tests for Early Infant Diagnosis in South Africa

Infant-HIV-Testing

HIV transmission and guidelines for screening

Mother-to-child HIV transmission, which can happen during pregnancy, labor, delivery, or breastfeeding, occurs at a rate of 15% to 45% with no intervention; however, effective interventions can reduce this rate to less than 5%.1 In settings with a high prevalence of HIV, WHO recommends provider-initiated HIV testing and care for all pregnant women, as well as retesting during the third trimester, during labor, or shortly after delivery.2 Women who test negative should be retested periodically if they breastfeed their infant so they can promptly receive interventions to prevent transmission to their infant.

Importance of testing newborns

Early identification of HIV infection in newborns is essential to initiate treatment promptly. Research has shown that babies with HIV are more likely to survive if they begin treatment before they are three months old.3 Without treatment, about one third of children living with HIV die by their first birthday and half die by their second birthday.4

The challenge: HIV testing for the most vulnerable

Although the implementation of prevention of mother to child transmission (PMTCT) services prevented an estimated 1.4 million HIV infections in children between 2010 and 2018,5 approximately 180,000 children were still newly infected with HIV in 2017.6 Additionally, only 52% of children with HIV were receiving ART in 2017, and 110,000 children died from AIDS-related illnesses caused by lack of access to effective care.6

Healthcare System Barriers

Many healthcare system-related barriers exist for PMTCT programs in countries with limited resources. For example, health care provider staff shortages, interruptions in medical supplies leading to delayed treatment, and shortages in counseling services are key contributing factors in loss to follow-up.

 

Hospital

Social Barriers

HIV-related stigma and discrimination plays a major role in participation in PMTCT programs and adherence to ART treatment. Women may report fear of telling their partners and family members of their HIV status and stop treatment if they are unable to explain why they and their newborn are taking medication.

Also, certain populations of pregnant women, such as sex workers, women who use injectable drugs, and adolescent women also face hurdles to finding out their HIV status and accessing PMTCT services due to restrictive policies (e.g., contraception bans under a certain age), discrimination in healthcare settings, and economic barriers.

GAP_HIV

What we are doing: Bravely facing HIV diagnosis together

 

The Global Access Program is the Roche Group’s proactive response to an enormous humanitarian challenge. Since its inception in 2014, the program has increased access to HIV testing at substantially reduced prices in sub-Saharan Africa and countries where the disease burden is highest. The Global Access Program focuses on the complete continuum of care, from testing to monitoring, education, and works to optimise efforts on a regional basis.

 

One of the reasons why we started the Global Access Program was to help overcome the hurdles preventing babies from being diagnosed. We pioneered new diagnostics methods for gathering and transporting blood samples enabling access to as many as possible. For example, blood samples can be taken at a local healthcare centre and dried on a card without need for refrigeration, and only requiring a small amount of blood, these cards can then be sent through the post for to laboratories.

 

We also introduced result delivery via text message (SMS) technology, making it easier to send test results back to rural healthcare facilities.

 

Improved communication means patients in rural and hard to reach areas to get answers quickly. Less travel means those who need it are more likely to return for treatment. Reducing significant barriers in HIV diagnosis and making care simpler.

 

Through the Global Access Program,  lab technicians across Sub-Saharan Africa are trained every year at our Roche Scientific Campus and partner training facilities Africa. We are continuing to add more programs to train healthcare workers in all areas of laboratory medicine.

The impact of our work: Sustainable treatment

In 2014 we collaborated with other organizations to launch the Global Access Program (GAP). GAP supports the 90-90-90 UNAIDS goal, expanding access to sustainable diagnostic testing for countries hardest hit by infectious disease.

Encouraging Statistics

  • The number of children younger than 15 receiving ART in low and middle income countries increased from 566,000 in 2011 to 936,000 in 20177
  • From 2010 to 2016 the number of children aged 0-14 years dying of AIDS-related illnesses was nearly cut in half in just six years8
  • 80% of pregnant women living with HIV received ARV medication in 2017 compared to 49% in 20099
  • Since Roche’s inception of the initial Public Private Partnership focused on Early Infant Diagnosis in 2009, annual infant screening has scaled up by more than 200%*. That is giving a lot more children a shot at life.

References

1. World Health Organization: Mother-to-child transmission of HIV. Available from: https://www.who.int/hiv/topics/mtct/en/ Accessed December 28, 2019

2. World Health Organization: Consolidated Guidelines on HIV Testing Services. Available from: https://apps.who.int/iris/bitstream/handle/10665/179870/9789241508926_eng.pdf?sequence=1. Accessed December 28, 2019.

3. Violari A, et al. Antiretroviral therapy initiated before 12 weeks of age reduces early mortality in young HIV-infected infants: evidence from the Children with HIV Early Antiretroviral Therapy (CHER) Study. Abstract no. WESS103. In: 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, 22–25 July 2007

4. United Nations AIDS: The GAP Report. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf. Accessed December 28, 2019

5. UNAIDS: Miles to Go: Global AIDS Update. Available at: https://www.unaids.org/sites/default/files/media_asset/miles-to-go_en.pdf. Accessed December 28, 2019.

6. UNAIDS: Start Free Stay Free AIDS Free: 2017 progress report. Available at: https://www.unaids.org/sites/default/files/media_asset/JC2923_SFSFAF_2017progressreport_en.pdf. Accessed December 28, 2019.

7. “HIV Positive Children (Aged 0-14) Receiving Antiretroviral Therapy.” Paediatric Care and Treatment, UNICEF, July 2018, data.unicef.org/wpcontent/uploads/2018/07/Paediatric_ART_2017.xlsx.

8. UNAIDS DATA 2017.” UNAIDS, 20 July 2017, www.unaids.org/en/resources/documents/2017/2017_data_book.

9. “Fact Sheet - Latest Global and Regional Statistics on the Status of the AIDS Epidemic.” UNAIDS, 18 July 2018, ww.unaids.org/en/resources/documents/2018/UNAIDS_FactSheet.