POC technology makes use of virological testing

DESPITE decreasing rates of mother to child transmission of HIV, each day more than 400 infants are born with HIV and nearly 350 infected children die from Aids worldwide.

Zimbabwe is not spared from the catastrophe.According to the National Aids Council (NAC) estimates one out of every eight children die before the age of five from HIV and Aids related causes.

While coverage of conventional, laboratory-based early infant diagnosis (EID) of HIV has increased in recent years, the turnaround time between sample collection and return of results takes at most three months. Ensuring prompt and adequate EID is still a challenge in many HIV endemic countries, a delay which can prove to be fatal as infants continue to succumb to Aids.

Globally, only half on infants born to mothers living with HIV undergo EID and of these, only half ever receive their test results. Ministry of Health and Child Care’s deputy national coordinator PMTCT and Paediatric anti-retroviral therapy, Dr Solomon Mukungunugwa welcomes the new device. “Many children born to parents living with HIV are being exposed to the virus and we have been losing quite a sizeable number. The POC device ensures that infants are screened on-site and quickly receive their test results,” said Dr Mukungunugwa.

“Though we are striving towards HIV elimination, there’s also a great need to increase the number of children with HIV on treatment to cover more than 85 percent of those in need so that we deal with the 21 percent mortality rate that is attributable to HIV.”

POC technology makes use of virological testing. A leading cause of child mortality in Zimbabwe is HIV/Aids which contribute to about 21 percent of deaths, followed by pneumonia, diarrhoea, measles and malaria.

Approximately two thirds of childhood deaths occur during infancy, with more than one third taking place during the first month of life. Infants living with HIV that are not initiated on anti-retroviral treatment (ART) have high mortality rates. This makes early infant diagnosis prompt return of results and rapid initiation on ART essential. World Health Organisation (WHO) pre-qualified Alere q and Cepheid GeneXpert devices for POC technology which are believed to perform well in the field when operated by a range of health professionals from nurses, laboratory technicians to medical doctors.

Before pre-qualification of the POC devices, trials were done in Kenya, Malawi, Mozambique, Tanzania, South Africa and Zimbabwe. “Virological testing is the only definitive way to conform HIV status in infants because of the presence of persisting maternal HIV antibody in children up to 18 months of age,” explained Mr Kenneth Maeka, the POC-EID technical advisor. “WHO recommends virological testing at between four and six weeks of age for HIV-exposed infants and new guidance also states that birth testing may be considered.”

In Zimbabwe, of the 77 000 children living with HIV and Aids, only 66 000 are on treatment. Though it hasn’t been made mandatory in Zimbabwe, all expectant mothers are encouraged go through under an HIV test once they realise they are pregnant as a measure towards prevention of mother to child HIV transmission (PMTCT). Late pregnancy booking has been cited as the major obstacle in implementing the national PMTCT programme.

The global target aims to reduce new HIV infections in children to less than five percent. A recent survey indicated that as of 2016, the country stands at 5,2 percent as the national target is less than five percent by end of this year.

HIV can be passed on from a mother to her baby during pregnancy, during delivery or whilst breastfeeding. Without any intervention, the chances that a baby born to an HIV positive mother will be infected are; 15-30 percent without breastfeeding and 25-45 percent with breast-                                                                                 feeding.

With interventions for PMTCT, the chances of mother to child transmission can be reduced by less than five percent in developing countries and to less than two percent in developed countries. Most clinics in the country offer HIV testing for exposed infants but there are reports of slow return of laboratory results to clinics at the moment.

With support from Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and other partners, Government has embarked on a nationwide distribution of the POC devices. “So far we have 100 devices in stock and our first port of call are hard to reach areas so they can access HIV diagnosis services,” Dr Mukungunugwa explained.

Zimbabwe is ranked among the 22 countries with the highest burden of pregnant women living with HIV.