The improvement of health outcomes of vertically infected infants requires earlier HIV diagnosis through greater adherence to the HIV testing schedules for HIV-exposed children.
This is a randomised controlled trial among HIV positive postpartum mother-baby dyads enrolled immediately after the postnatal consultation at four midwife obstetric units in Gauteng (South Africa) and randomised into (A) Motivational Interviewing (MI) retention counselling by lay counsellors at baseline and telephonically at six and 12-month, (B) bi-annual tracing calls, (C) standard care. Mother-baby pairs were followed up to 18 months postpartum telephonically and via paper files (25 primary care clinics) and electronic medical records (a search of the National Health Laboratory Services database). Log-binomial regression was used to assess the timing of the ten-weeks infant polymerase chain reaction (PCR) test, the uptake of the child 18-months antibody test, maternal retention and viral load (VL) suppression at six, 12 and 18-month postpartum.
Overall, 710 mother-baby pairs were recruited with a median age of 30 years (interquartile range: 25-34). While, 70.1% of HIV-exposed babies received a second HIV PCR test by six-month (70.0% in the MI intervention group, 70.5% in the control groups B and 70.0% in group C), among those tested (n=501), 85.0% of the intervention (A) children were tested at 7-90 days of age, 69.0% in group B and 75.3% of group C (adjusted Risk Ratio (aRR)=1.13 for the MI intervention vs. group C (95% Confidence Interval (CI): 1.0-1.3) and aRR 1.2 vs. group B (95%CI: 1.1-1.4)). Overall only 58 (8.2%) children were tested at 18-months (10.7% group A, vs 5.5% in group C, RR 2.0, 95% CI: 1.0-3.7) with a final vertical transmission rate of 0.7%. Maternal retention and VL suppression rates were similar across randomisation groups at 349 (49%) retained at six months (180/226 VL suppressed), 151 (21%) at 12 months (93/114 VL suppressed), 130 (18%) at 18-months (99/111 suppressed).
MI retention counselling by unskilled lay personnel is feasible and can reduce delays in the uptake early infant diagnostic tests for HIV-exposed infants. However, greater efforts are needed to improve adherence to the 18-months child antibody test, postpartum maternal retention in HIV care and viral monitoring.