Wednesday, April 5, 2017
New test to detect HIV in babies boosts hope of meeting UN targets
This was originally published on Global Health TV on October 25, 2016.
When Saquina, a 38-year-old single mother living in Nacala Porto, Mozambique, learned she was HIV positive while pregnant, she thought her life was over. Instead, she decided to accept her HIV status and follow the advice of the nurse who counseled her.
She did not miss any visits to the health center. She took the pills that helped prevent transmission of the virus to her unborn child. She participated in support groups with other HIV-positive mothers. When her son Frenchou was born, she gave him medication every day and breastfed him exclusively for six months.
When he was two years old, Frenchou was tested for HIV and found negative — another of many recent successes in the prevention of mother-to-child transmission (PMTCT), according to the Elizabeth Glaser Pediatric AIDS Foundation.
Between 2009 and 2015, there was a 60% decline in new HIV infections in children in the 21 priority countries, according to a UNAIDS report released in June. Seven of those countries reduced infections by more than 70%. A total of 1.2 million new infections among children were averted in these countries.
But if you thought thought that all is now well with PMTCT, and that we can move on to other HIV challenges, you would be mistaken. While a 60% drop is certainly encouraging, it is significantly below the 90% target set by the World Health Organization (WHO). UNAIDS has set a goal of eliminating all new HIV infections among children by 2020 while ensuring that 1.6 million children have access to HIV treatment by 2018.
Every day, an estimated 400 children are infected with HIV. When children with HIV are not diagnosed and treated promptly, as many as one-third will die before their first birthday and half before their second birthday.
But to achieve this goal, early infant diagnosis has been a major stumbling block. Up to now, infant testing has imposed a lag time between the test and the results of 3 to 6 weeks.
We know that if mothers and babies have to return to the clinic for test results weeks later, they are less likely to get the results and start treatment. “About 50 percent of infants who are tested do not receive their test results and, of those children who test positive, 40 percent never receive treatment,” notes the Elizabeth Glaser Pediatric AIDS Foundation.
That’s why a new technology for testing infants in less than one hour is so exciting. Alere, a U.S.-based company in rapid diagnostic products and services, says the test — called the Alere q HIV-1/2 Detect — is the first ever molecular diagnostic that identifies HIV-1 and HIV-2 in a health facility (Alere calls this “point-of-care testing”) in less than one hour. The technology allows HIV-positive babies to be put on treatment immediately. It also eliminates the problem of mothers not returning to the clinic for their test results.
Alere believes point-of-care testing will accelerate testing of infants, especially in South Africa, which has the highest HIV burden in the world. Currently, an estimated 11.2% of the population is living with the disease. South Africa is piloting the test in two health centers in the Western Cape.
“Currently, most newborns in developing countries are screened for HIV infection via dry blood spot testing, but because health workers have to wait 3 to 6 weeks for results many potentially HIV-positive infants are lost to follow-up and remain untreated,” said Dr. Landon Meyer, a professor at the School of Public Health and Family Medicine at the University of Cape Town. “The ability to provide to a patient’s mother a definitive test result — when before we would often conduct a test and mothers wouldn’t come back — the ability to provide that on-site within 52 minutes really is an epiphany. It’s a revelation.”
“There have been massive successes in PMTCT over the last decade, particularly in South Africa, but what we realize more and more is that the battle is not won and it’s going to be a very long time before we eradicate pediatric HIV infection, and so technologies like the [Alere] q become more important to us in practice.”
Pilots are also taking place in Malawi and Mozambique, and Kenya is looking at the possibility of using this test.
In June, Alere won prequalification from WHO, meaning the technology can be widely implemented by organizations and governments, and used by health workers to diagnose HIV infections rapidly, allowing for a more timely initiation of anti-retroviral therapy.
Anti-retroviral treatment is very effective in children with HIV, transforming it from a death sentence to a long-term, manageable condition, according to NAM. Many experts believe that treated children will have almost normal life expectancy.
If we can improve diagnostics and treatment, and deliver them to those children who need them, we will have more happy endings, like the inspiring 21-year-old Lerato, from South Africa, who was born with HIV. Now she says “There’s more to life than HIV. It’s not stopping me. I can do anything I want.”