Cape Town - The way labour wards classify the risk of HIV in high-risk babies is inadequate.
This is according to a recent study published in the South African Medical Journal that looked at the recognition of infants at high risk for HIV transmission at delivery.
Experts from Stellenbosch University wanted to determine the number of infants at high risk for the virus and the accuracy of labour-ward risk classification.
Halting new HIV infections among children is a crucial step towards the World Health Organization’s global goal to end the Aids epidemic by 2030, the authors explained.
“South Africa paediatric HIV incidence exceeded 750 per 100 000 live births due to the high antenatal HIV prevalence of 30.7%,” the report stated.
Researchers found that while early maternal viral suppression through antiretroviral therapy (ART) represents the foundation of preventing transmission, many women living with HIV fail to receive sustained maternal antiretroviral therapy required to achieve HIV viral load suppression before and during pregnancy.
“This is as a result of challenges in the uptake and implementation of the HIV transmission-prevention programme including ongoing barriers to ART access, the time lag between introduction and implementation of revised policies, suboptimal training and knowledge of these policies by providers as guidelines have rapidly evolved, incomplete programme uptake and progressive drop-out numbers.”
For the study, the researchers used data for women living with HIV who delivered their infants at a rural regional hospital in the Western Cape between May, 2016 and April, 2017.
“In this regional-level labour ward, 40% of 188 infants were classified as high risk for transmission at the time of delivery. However, 69% were actually high risk after applying criteria documented in clinical records.
“Of the eight HIV transmissions, one was a correctly assigned low-risk infant and seven were high-risk infants.
“Five of these were correctly identified and two incorrectly classified.”
The low sensitivity for detecting high-risk infants meant that half of all live born high-risk infants went unrecognised and therefore were not considered for dual enhanced antiretroviral prophylaxis, said the researchers.
The current 2020 Western Cape HIV guidelines now recommend that all women should receive HIV viral load monitoring (HIV-VL) at delivery.
“Unless the HIV-VL result is available prior to the mother and infant being discharged from the delivery unit, it is unlikely to prove very helpful for correct infant risk classification and provision of appropriate and timeous infant prophylaxis,” said the study.
It has been recommended that current guidelines and their implementation could be strengthened by “reinforcing antenatal-visit frequency, particularly later in pregnancy by simplifying HIV viral load monitoring and considering better monitoring strategies”.
Cape Times