Point-of-care HIV diagnosis for infants: the outcomes we need to achieve

Most of the examined studies did not provide enough data on mortality, retention in care, and viral suppression, although the absolute numbers of infants found to have HIV was high (1018 [4·0%] in the point-of-care testing group vs 428 [3·5%] in the standard-of-care testing group). While the study o...

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Bibliographic Details
Published in:The Lancet (British edition) 2022-09, Vol.400 (10356), p.864-865
Main Authors: Technau, Karl-Günter, Mazanderani, Ahmad Haeri
Format: Article
Language:English
Subjects:
Antiretroviral therapy
Babies
Children & youth
Cost analysis
Diagnosis
Diagnostic tests
Families & family life
HIV
Human immunodeficiency virus
Infants
Medical diagnosis
Medical tests
Mortality
Pediatrics
Point of care testing
Retention
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Summary:Most of the examined studies did not provide enough data on mortality, retention in care, and viral suppression, although the absolute numbers of infants found to have HIV was high (1018 [4·0%] in the point-of-care testing group vs 428 [3·5%] in the standard-of-care testing group). While the study offers evidence for early clinical effects of point-of-care HIV diagnosis in infants (access to diagnosis and early ART), longer-term effects, such as on mortality, retention in care, and viral suppression, require more attention and further research. High mortality rates of greater than 10% at age 1 year remain, even among infants diagnosed with point-of-care testing at birth.8,9 Shortfalls of paediatric HIV management include laboratory, service-delivery, and systems issues.5 Crucially, attention to family care and inclusion of the mother's needs are essential if poor retention in care is to be effectively addressed.10 Loss to follow-up in women and children attending HIV care is multifactorial and related to personal, family, community, and health-systems issues.11 Individualised psychosocial support is therefore necessary, and needs to consider the complex interactions that exist between patients, parents, and health-care providers,12,13 with family care shown to be a useful model to improve follow-up and retention.14 Point-of-care diagnosis of HIV is an intervention that supports a first step towards addressing a much larger and complex problem.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(22)01695-6