CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme.

Background: People living with HIV (PLHIV) who have low CD4 counts require advanced clinical care (ACC) to minimise morbidity and mortality risk. These patients include immunological non-responders (INRs) with low CD4 counts despite a suppressed viral load.

Objectives: To determine the proportion of patients with low CD4 counts after antiretroviral therapy (ART) initiation and to describe INRs within that group.

Same-day antiretroviral therapy initiation for HIV-infected adults in South Africa: Analysis of routine data.

Same-day initiation (SDI) of antiretroviral therapy (ART) has been recommended to improve ART programme outcomes in South Africa since August 2017. This study assessed implementation of SDI over time in two South African districts, describing the characteristics of same-day initiators and evaluating the impact of SDI on retention in ART care. Routine data were analysed for HIV-infected adults who were newly initiating ART in Johannesburg or Mopani Districts between October 2017 and June 2018.

Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package.

Visual impairment is a significant public health concern, particularly in low- and middle-income countries where eye care is predominantly provided at the primary healthcare (PHC) level, known as primary eye care. This study aimed to perform an evaluation of primary eye care services in three districts of South Africa and to assess whether an ophthalmic health system strengthening (HSS) package could improve these services. Baseline surveys were conducted in Cape Winelands District, Johannesburg Health District and Mopani District at 14, 25 and 36 PHC facilities, respectively.

A mathematical model evaluating the timing of early diagnostic testing in HIV-exposed infants in South Africa.

Background: Antiretroviral therapy is often initiated too late to impact early HIV-related infant mortality. Earlier treatment requires an earlier diagnosis, and the currently recommended 6-week HIV polymerase chain reaction (PCR) test needs reconsideration. This study aims to identify (1) optimal testing intervals to maximize the number of perinatal HIV infections diagnosed and (2) programmatic issues that impact diagnosis.

Birth diagnosis of HIV infection in infants to reduce infant mortality and monitor for elimination of mother-to-child transmission.

Background: Early initiation of antiretroviral therapy depends on an early infant diagnosis and is critical to reduce HIV-related infant mortality. We describe the implementation of a routine prevention of mother-to-child transmission program and focus on early infant diagnosis to identify opportunities to improve outcomes.

Methods: HIV-exposed infants and their mothers were enrolled in a prospective, observational cohort study at a routine, hospital-based prevention of mother-to-child transmission and HIV treatment service in Johannesburg, South Africa.

Early diagnosis of in utero and intrapartum HIV infection in infants prior to 6 weeks of age.

Early initiation of antiretroviral therapy reduces HIV-related infant mortality. The early peak of pediatric HIV-related deaths in South Africa occurs at 3 months of age, coinciding with the earliest age at which treatment is initiated following PCR testing at 6 weeks of age. Earlier diagnosis is necessary to reduce infant mortality.

The performance of 5 rapid HIV tests using whole blood in infants and children: selecting a test to achieve the clinical objective.

Background: Rapid tests have the potential to improve the identification of HIV-infected children in resource-limited settings. However, they remain underutilized because of a lack of data on their performance in the field using whole blood specimens. This study aimed to assess the accuracy of rapid tests for detecting HIV exposure, excluding HIV infection in HIV-exposed infants, and diagnosing HIV infection in children older than 18 months of age.

Oral fluid tests for screening of human immunodeficiency virus-exposed infants.

In high human immunodeficiency virus (HIV) prevalence settings, routine screening of infants attending immunization visits could improve identification of HIV-exposed infants to receive an early diagnosis and appropriate interventions. This first assessment of 2 rapid oral fluid HIV tests in early infancy demonstrates a sensitivity of <90% for detection of HIV-exposure resulting in failure to detect at least 1 in 10 HIV-infected infants.