Sustained maternal human immunodeficiency virus viral load suppression and cascade of human immunodeficiency virus testing among exposed infants in Rwanda

Introduction:Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017.Methods:This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression).Results:Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months.Conclusions:While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.

Mexico's evolving HIV epidemic.

To determine whether implementation of provider-initiated human immunodeficiency virus (HIV) counseling would increase the proportion of tuberculosis (TB) patients who received HIV counseling and testing. Cluster-randomized trial with clinic as the unit of randomization. Twenty, medium-sized primary care TB clinics in the Nelson Mandela Metropolitan Municipality, Port Elizabeth, Eastern Cape Province, South Africa. A total of 754 adults (18 years and older) newly registered as TB patients in the 20 study clinics. Implementation of provider-initiated HIV counseling and testing. Percentage of TB patients HIV counseled and tested. SECONDARY: Percentage of patients with HIV test positive, and percentage of those who received cotrimoxazole and who were referred for HIV care. : A total of 754 adults newly registered as TB patients were enrolled. In clinics randomly assigned to implement provider-initiated HIV counseling and testing, 20.7% (73/352) patients were counseled versus 7.7% (31/402) in the control clinics (P = 0.011), and 20.2% (n = 71) versus 6.5% (n = 26) underwent HIV testing (P = 0.009). Of those patients counseled, 97% in the intervention clinics accepted testing versus 79% in control clinics (P = 0.12). The proportion of patients identified as HIV infected in intervention clinics was 8.5% versus 2.5% in control clinics (P = 0.044). Fewer than 40% of patients with a positive HIV test were prescribed cotrimoxazole or referred for HIV care in either study arm. Provider-initiated HIV counseling significantly increased the proportion of adult TB patients who received HIV counseling and testing, but the magnitude of the effect was small. Additional interventions to optimize HIV testing for TB patients urgently need to be evaluated.

In Brief Objective To report the experience with state-mandated voluntary newborn human immunodeficiency virus (HIV) screening in a large university hospital. Methods Retrospective analysis of delivery records and newborn HIV screening data for infants born between May 4, 1996, and January 31, 1997. Results Of 3111 women, 40% had HIV testing during pregnancy, 28% had testing before pregnancy, 30% never had testing, and 2% gave no information. Most (91%) consented to postpartum newborn HIV testing, although rates varied by HIV counselor (range 81–96%, P < .001) and maternal HIV testing history (range 72–94%, P < .001). Maternal antepartum HIV testing rates varied by delivering physician (range 8–100%, P < .001) and by antepartum care site (clinics, 83%; faculty practices, 72%; private practices, 57%; P < .001). Fourteen HIV-exposed infants (0.46% of infants tested) were identified, 13 of whom were born to women known to be HIV positive before delivery. These women had received zidovudine prophylaxis according to Adult AIDS Clinical Trials Group 076 guidelines. All 14 infants subsequently tested negative for HIV. Human immunodeficiency virus–positive women were more likely than HIV-negative women to have received antepartum care in clinics (93% compared with 11%), have care paid by Medicaid (93% compared with 28%), and reside in high-risk areas (72% compared with 11%) (P < .001). Conclusion Newborn HIV screening has little incremental impact in settings with aggressive antepartum screening and/or low HIV infection rates. Interventions to increase antepartum HIV screening in the private sector should be implemented. Despite marked differences in antepartum human immunodeficiency virus screening practices between hospital-based and private practices, voluntary newborn human immunodeficiency virus screening had no additional impact because of aggressive antepartum screening in the former and low rates of infection in the latter.

To assess the stability of human immunodeficiency virus (HIV) viral load suppression within 1 month before birth in pregnant women receiving antenatal combination antiretroviral therapy (CART). This is a retrospective cohort study of a Canadian provincial perinatal HIV database from 1997 to 2015. Inclusion criteria were live birth and CART received for at least 4 weeks. Viral load rebound, defined as viral load greater than 50 copies/mL (or greater than 400 copies/mL for 1997-1998) and measured within 1 month before delivery, was identified in women who had at least one previous undetectable viral load during pregnancy. Logistic regressions were conducted to identify the risk factors for viral load rebound. Among the 470 women in the database, 318 met inclusion criteria. Viral load rebound was experienced by 19 women (6.0%, 95% CI 3.7-9.3%) with a mean log10 viral load near delivery of 2.71 copies/mL (=513 copies/mL). Six (32%) had a viral load above 1,000 copies/mL. The rebound was detected within 1 day before delivery in 50% of the women. Aboriginal ethnicity, cocaine use, and hepatitis C virus polymerase chain reaction positivity were significantly associated with viral load rebound. There were no HIV vertical transmissions. Even women attending for HIV care and achieving viral suppression in pregnancy can experience viral load rebound predelivery.

Optimal blood donation screening annotation.

Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13-64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals. During the pre-intervention period (2.5-4 months), an electronic "HIV Testing" order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert. The percentage of visits where an HIV test was performed increased from 5.4% in the preintervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%). An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.

In Brief Objective To determine if awareness of methods to reduce vertical transmission of human immunodeficiency virus (HIV) is associated with HIV test acceptance and to clarify patients' attitudes toward routine versus elective prenatal HIV testing. Methods In a cross-sectional study, 247 antenatal patients were surveyed regarding HIV knowledge, self-perceived HIV risk, and willingness to learn a positive test result. This information, along with demographic and risk factor data, was related to HIV test acceptance. Patients also indicated their attitudes toward routine versus elective prenatal testing for HIV and other common prenatal screening tests. Results Seventy-two percent of antenatal patients accepted HIV testing. Test acceptance was not associated with the presence of risk factors, self-perceived HIV risk, or demographic factors, including race and ethnicity. Test acceptance was associated positively with patients' knowledge of a medical intervention to reduce vertical transmission and their willingness to learn a positive HIV test result. Only 24% of patients knew that the risk of vertical transmission could be reduced using medication. Sixty-nine percent of patients said that prenatal HIV testing should be routine, whereas 27% said that it should be done only after specific written consent. As a group, our patients viewed HIV screening no differently from screening for other infections in pregnancy. Conclusion Interventions aimed at increasing HIV testing rates among pregnant women should focus on educating patients about vertical transmission reduction and promising new therapies for HIV infection. Proponents of elective testing should re-evaluate the assumption that patients view HIV testing differently from other prenatal tests for which separate written consent is not required. Most pregnant women will accept testing for human immunodeficiency virus if they know that a medication exists to reduce transmission to their infants, but few are aware of this intervention.

PIN50 NON-SEXUAL RISK BEHAVIORS ARE ASSOCIATED WITH INCREASED ODDS OF HIV TESTING: RESULTS FROM THE 2017 BRFSS

With the waiver of the Orasure Oraquick rapid human immunodeficiency virus (HIV) test in January 2003, testing for HIV infection in the United States moved from the laboratory to the clinic, the emergency room, and other outpatient settings. By now, millions of rapid HIV tests have been performed, largely by nonlaboratorians and largely outside of dedicated laboratory space. This experience has significantly transformed HIV testing nationally. The next logical step in broadening the settings in which HIV testing can be performed, approval of an HIV test for sale “over the counter” (OTC), involves clinical, technical, psychological, and public health issues along with a fair sprinkling of politics. Much of the rationale for both rapid, “waived” and home-use HIV testing can be summarized by two simple statistics: (i) approximately 30% of HIV-infected persons in the United States are unaware of their serostatus, and (ii) in 2004, 39% of persons with AIDS (e.g., opportunistic infection or CD4+-T-cell count of <200) first tested positive for HIV within 1 year of their AIDS diagnosis (7). Current evaluative approaches are missing substantial numbers of infected persons and detect HIV infection at a later stage than is optimal. Expanding access to HIV testing is a logical approach to addressing these inadequacies. Newly proposed methods for HIV testing must be compared not with an ideal system but with the current state of HIV surveillance and testing. In the United States, kits for home diagnostic testing are available for a limited set of analytes (9). There are currently no OTC tests for infectious diseases; tests for group A streptococcal pharyngitis and for influenza were rejected for home use due to insufficient sensitivity. There are, however, home collection kits for hetatitis C virus and HIV infection that allow consumers to collect specimens and send them to laboratories for testing and direct reporting. The scientific literature on home testing has recently been reviewed and can best be described as “sparse” (12). There have been few studies of the accuracy of home testing methods beyond those performed for Food and Drug Administration (FDA) approval. Even for well-established practices such as home glucose monitoring, there are limited data with respect to outcomes: the recommendations of the American Diabetes Association and the World Health Organization are based primarily on cohort studies and expert opinion and not on controlled studies showing a clinically significant impact on outcomes. The randomized clinical trials that have been performed demonstrated mixed results; a few showed improvement in outcome measures such as hemoglobin A1c levels, but more trials showed no significant effects. Although tests are widely available, an estimation of the clinical or public health impact of any home testing method is nearly pure guesswork at this time.

Pregnant and breastfeeding women living with HIV (WLHIV) are a target population for elimination of mother-to-child transmission of HIV (eMTCT). However, there are limited data on maternal virological responses during pregnancy and the postpartum period in South Africa (SA).To review compliance of viral load (VL) testing with national guidelines and suppression rates during pregnancy and up to 9 months postpartum among WLHIV delivering in four tertiary hospitals in Gauteng Province, SA.All women who had a point-of-care HIV VL test using Xpert HIV-1 VL (Cepheid, USA) at delivery in four tertiary obstetric units in Gauteng between June 2018 and February 2020 were included. HIV VL tests of eligible women performed up to 9 months before and after delivery were extracted from the National Health Laboratory Service's Corporate Data Warehouse. Proportions of women delivering who had antenatal and postpartum VL tests performed and their suppression rates were determined and expressed as percentages.Of 4 989 eligible WLHIV (median age 31.1 years), 917 (18.4%) had a VL performed during the antenatal period; of these, 335 (36.5%) had a VL ≥50 copies/mL and 165 (18.0%) a VL ≥1 000 copies/mL. At delivery, 1 911 women (38.3%) had a VL ≥50 copies/mL and 1 028 (20.6%) a VL ≥1 000 copies/mL. Among 627 women (12.6%) with a VL test postpartum, 234 (37.3%) had a VL ≥50 copies/mL and 93 (14.8%) a VL ≥1 000 copies/mL. Overall, having a VL test performed during the antenatal period was associated with viral suppression at delivery and receiving a VL test postpartum (p&lt;0.001). Women with a VL ≥50 copies/mL at delivery were more likely to be younger and to remain virally unsuppressed postpartum (p&lt;0.001) compared with women with a VL &lt;50 copies/mL.Fewer than 5% of WLHIV with a VL at the time of delivery received VL monitoring during the antenatal and postpartum periods in accordance with national guidelines. More than 80% of WLHIV delivering had no evidence of VL monitoring during the antenatal period, and they were more likely than women who received monitoring during the antenatal period to be virally unsuppressed at delivery and to receive no VL monitoring postpartum. Women with a high VL at delivery were likely to remain virally unsuppressed postpartum. These results emphasise the need for closer monitoring of and rapid reaction to high maternal VLs during pregnancy, at delivery and postpartum for attainment of eMTCT.

HIV (Human Immunodeficiency Virus) is a virus that causes decreased immunity. Examinations that can be done for HIV testing include a rapid HIV test and HIV viral load. The rapid HIV test is a test that is used to find out the antibodies in the sample, while the viral load test is to find out the amount of HIV. The purpose of this study was to compare HIV using a rapid test with HIV viral load in people with HIV. This type of research is observational with a cross-sectional approach. The sample in this study were 30 samples from HIV sufferers who carried out an HIV viral load examination using the Molecular Rapid Test (TCM) method at the RSUD Haji Provinsi Jawa Timur, then a rapid HIV test was carried out using the immunochromatography method. The results of the HIV rapid test and HIV viral load were processed in the form of a bar chart and tested with the McNemar statistical test. The results of the McNemar test can be concluded that there is a significant difference between the results of the HIV viral load examination of HIV viral load by the Molecular Rapid Test (TCM) method is superior to the HIV rapid test. However, rapid tests can be used in diagnosing HIV infection.

Laboratory Industry Perspectives on the Role of Self-Collection and Self-Testing in Remote Care for Sexually Transmitted Infections: How Do We Bring These Services to Scale?

Combined antiretroviral therapy (cART) attenuates hepatic fibrosis in hepatitis C virus and HIV coinfected patients. However, the role of HIV or cART on hepatic fibrosis in HIV monoinfection is discussed controversially. During liver fibrosis, matrix metalloproteinases (MMPs) degrade extracellular matrix (ECM) proteins into small soluble fragments, which reflect hepatic remodeling processes. This study used these novel biomarkers to investigate the effect of HIV and cART on hepatic fibrosis remodeling. In 249 patients with HIV monoinfection and 55 healthy controls, the serum levels of MMP-degraded collagen type III (C3M), biglycan (BGM), elastin (ELM), as well as the formation marker 7S (P4NP 7S), and MMP-degraded collagen type IV (C4M) were determined using specific ELISAs. Sixty-eight patients underwent a follow-up visit 3 years later including assessment of ECM markers and fibrosis using transient elastography (Fibroscan). C3M, BGM, C4M and P4NP 7S were significantly elevated in HIV patients compared to controls and correlated to HIV viral loads and inversely to cART duration. C4M, P4NP 7S and ELM were lower in patients under cART therapy and in patients without HIV viremia, indicating that lowering of the HIV load by cART attenuates remodeling of ECM. The levels of C3M, C4M, P4NP 7S and ELM correlated significantly with the progression of fibrosis in these patients. Specific therapy of patients with HIV monoinfection also beneficially influences liver fibrosis. These novel markers of liver fibrosis remodeling may help to monitor the hepatic effects by HIV therapy.

Impact of the COVID-19 pandemic on an emergency department-based opt-out HIV screening program in a South Florida hospital: An interrupted time series analysis, July 2018-March 2021