Effects of the COVID-19 pandemic on early infant diagnosis of HIV in Cape Town, South Africa

Hendrike van Vollenhoven; Emma Kalk; Stuart M Kroon; Tafadzwa Maseko; Florence Phelanyane; Jonathan Euvrard; Lezanne Fourie; Nicolene le Roux; Phumza Nongena

doi:10.4102/sajhivmed.v25i1.1542

Effects of the COVID-19 pandemic on early infant diagnosis of HIV in Cape Town, South Africa

South Afr J HIV Med. 2024 Mar 18;25(1):1542. doi: 10.4102/sajhivmed.v25i1.1542. eCollection 2024.

Authors

Hendrike van Vollenhoven¹, Emma Kalk², Stuart M Kroon¹, Tafadzwa Maseko³, Florence Phelanyane⁴, Jonathan Euvrard⁴, Lezanne Fourie⁵, Nicolene le Roux⁶, Phumza Nongena¹

Affiliations

¹ Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
² School of Public Health, Faculty of Health Science, University of Cape Town, Cape Town, South Africa.
³ Family Medicine and Population Health (FAMPOP), Department of Epidemiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
⁴ Health Intelligence Directorate, Western Cape Department of Health, Cape Town, South Africa.
⁵ Department of Neonatology, Mowbray Maternity Hospital, Cape Town, South Africa.
⁶ HIV/AIDS, STI's and Tuberculosis Directorate (HAST), New Somerset Hospital, Cape Town, South Africa.

Abstract

Background: In South Africa, infants who are HIV-exposed are tested for HIV at birth and 10 weeks of age. The COVID-19 pandemic lockdown restrictions resulted in reduced access to healthcare services and uncertain impact on early infant HIV testing.

Objectives: To describe the effects of the COVID-19 pandemic lockdown restrictions on early infant HIV testing and diagnosis in Cape Town, South Africa.

Method: This retrospective cohort study compares HIV-exposed infants born during the first COVID-19 pandemic lockdown (2020) to those born in the same period the year before (2019). Laboratory and other data were abstracted from the Provincial Health Data Centre.

Results: A total of 2888 infants were included: 1474 born in 2020 and 1413 in 2019. Compared to 2019, there was an increase in the 10-week HIV polymerase chain reaction (PCR) uptake in 2020 (71% vs. 60%, P < 0.001). There was also an increase in the proportion of infants who demised without 10-week testing or were lost to follow-up in 2020 compared to 2019 (8% vs. 5%, P = 0.017). Differences detected in birth HIV PCR positivity rates between the two groups (1.1% vs. 0.5%, P = 0.17) did not reach statistical significance; however, a significant increase in vertical transmission of HIV by 10 weeks old was found in the 2020 cohort (1.2% vs. 0.5%. P = 0.046).

Conclusion: Vertical transmission of HIV at 10 weeks increased in the Cape Town Metropolitan during the initial COVID-19 lockdown. There was also an increase in the proportion of deaths without testing by 10 weeks in the 2020 group.

Keywords: COVID-19; HIV; PMTCT; VTP; early infant diagnosis; prevention of mother-to-child transmission; vertical transmission; vertical transmission prevention.

Grants and funding

Funding information This work was supported by the University’s MMED fund and the Departmental Research Committee.