ABSTRACT

Evidence-based interventions are urgently needed to successfully achieve the elimination of mother to child transmission of HIV. This study aimed to evaluate the impact of a default tracking programme on the outcomes of infants exposed to HIV. We conducted a longitudinal cohort study of mothers infected with HIV. We established a default tracking programme for HIV-infected mother-infant pairs using a multidisciplinary team with clear lines of responsibilities. Infants exposed to HIV who did not return for the assessment of their infection status were defined as ‘defaulters’. The defaulters were tracked and classified as linked to care or ‘lost to follow-up’ (LTFU) if they were not re-engaged in care. Within the study cohort, we investigated LTFU at 6 weeks, 4 months, and 18 months, linkage-to-care, and laboratory outcomes. Between 2012 and 2017, there were 454 live-births, 25 transfers, 2 deaths, 8 cases of HIV infection, 136 defaulters, and 68 infants LTFU. The number of children who defaulted care reduced from 44% in 2012 to 7% in 2017 (p = 0.0001)). Infants LTFU reduced significantly from 21% to 4% (p = 0.0001). The prevalence of negative PCR1 increased significantly from 75% to 97% (p = 0.002), while that for positive PCR declined from 4% to 0%. The seroconversion rate was 1.9%. Of the 68 infants LTFU among the entire cohort, 18 (4%) were lost at 6 weeks, 14 (3%) at 4 months, and 36 (9%) at 18 months (p = 0.025). Thirty-four of the LFTU (97%) at 18 months tested negative for PCR1, and 31 (89%) tested negative for PCR 2. Three defaulters that were linked-to-care had HIV infection. Multidisciplinary service packages and the tracking of mother-infant pairs who default from care had a positive impact on reducing LTFU and increasing PCR uptake in this non-breastfeeding population.

摘要

迫切需要采取循证干预措施，以成功消除艾滋病毒的母婴传播。这项研究旨在评估默认跟踪程序对暴露于HIV的婴儿结局的影响。我们对感染艾滋病毒的母亲进行了纵向队列研究。我们使用职责明确的多学科团队为HIV感染的母婴建立了默认跟踪程序。那些没有返回以评估其感染状况的暴露于艾滋病毒的婴儿被定义为“违法者”。跟踪违约者并将其分类为与照护相关，或者如果他们没有重新参与照护，则将其分类为“失访”。在研究队列中，我们调查了6周，4个月和18个月时的LTFU，与护理的联系以及实验室结果。在2012年至2017年之间，有454例活产，25例转移，2例死亡，8例HIV感染，136例违法者和68例LTFU婴儿。拖欠照料的儿童人数从2012年的44％下降到2017年的7％（p = 0.0001）。婴儿的LTFU从21％显着降低到4％（p = 0.0001）。阴性PCR1的患病率从75％显着增加到97％（p = 0.002），而阳性PCR1的患病率从4％下降到0％。血清转化率为1.9％。在整个队列中的68例婴儿LTFU中，第6周有18例（4％）丢失，第4个月有14例（3％）丢失，而18个月有36例（9％）丢失（p = 0.025）。在18个月时，有34％的LFTU（97％）对PCR1呈阴性，而31个（89％）对PCR 2呈阴性。与护理有关的三个违法者感染了HIV。