PMID- 29852062 OWN - NLM STAT- MEDLINE DCOM- 20190513 LR - 20231112 IS - 1758-2652 (Electronic) IS - 1758-2652 (Linking) VI - 21 IP - 5 DP - 2018 May TI - Targeted HIV testing at birth supported by low and predictable mother-to-child transmission risk in Botswana. PG - e25111 LID - 10.1002/jia2.25111 [doi] LID - e25111 AB - INTRODUCTION: Most African countries perform infant HIV testing at 6 weeks or later. The addition of targeted testing at birth may improve retention in care, treatment outcomes and survival for HIV-infected infants. METHODS: HIV-exposed infants were screened as part of the Early Infant Treatment (EIT) study in Botswana. Screened infants were >/=35 weeks gestational age and >/=2000 g at birth. Risk factors for mother-to-child transmission (MTCT) were assessed by maternal obstetric card or verbally. Risk factors included <8 weeks ART in pregnancy, last known CD4 <250 cells/mm(3) , last known HIV RNA >400 copies/mL, poor maternal ART adherence, lack of maternal zidovudine (ZDV) in labour, or lack of infant post-exposure prophylaxis. Infants underwent dried blood spot testing by Roche Cobas Ampliprep/Cobas Taqman HIV-1 qualitative PCR. RESULTS: From April 2015 to April 2016, 2303 HIV-exposed infants were tested for HIV in the EIT study. Of these, 369 (16%) were identified as high risk for HIV infection by information available at birth, and 12 (0.5% overall, 3.25% of high risk) were identified as HIV positive at birth. All 12 positive infants were identified as high risk at the time of screening, and only 2 risk factors were required to identify all positive infants: either <8 weeks of maternal ART in pregnancy (75%) or lack of maternal HIV suppression at last test (25%). CONCLUSIONS: In utero MTCT occurred only among infants identified as high risk at delivery, using information available from the mother or obstetric record. Birth testing that targets high-risk infants based on maternal ART receipt is likely to identify the majority of in utero HIV transmissions, and allows early ART initiation for these infants. CI - (c) 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. FAU - Ibrahim, Maryanne AU - Ibrahim M AD - Harvard Medical School Doris Duke International Clinical Research Fellowship, Boston, MA, USA. AD - University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA. AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. FAU - Maswabi, Kenneth AU - Maswabi K AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. FAU - Ajibola, Gbolahan AU - Ajibola G AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. FAU - Moyo, Sikhulile AU - Moyo S AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. FAU - Hughes, Michael D AU - Hughes MD AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. AD - Department of Biostatistics, Harvard T.H Chan School of Public Health, Boston, MA, USA. FAU - Batlang, Oganne AU - Batlang O AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. FAU - Sakoi, Maureen AU - Sakoi M AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. FAU - Auletta-Young, Chloe AU - Auletta-Young C AD - Department of Immunology and Infectious Diseases, Harvard T.H Chan School of Public Health, Boston, MA, USA. FAU - Vaughan, Laura AU - Vaughan L AUID- ORCID: 0000-0003-3517-6543 AD - Department of Immunology and Infectious Diseases, Harvard T.H Chan School of Public Health, Boston, MA, USA. FAU - Lockman, Shahin AU - Lockman S AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. AD - Infectious Disease Division, Brigham and Women's Hospital, Boston, MA, USA. FAU - Jean-Philippe, Patrick AU - Jean-Philippe P AD - National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. FAU - Yu, Xu AU - Yu X AD - Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA. FAU - Lichterfeld, Matthias AU - Lichterfeld M AD - Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA. FAU - Kuritzkes, Daniel R AU - Kuritzkes DR AD - Infectious Disease Division, Brigham and Women's Hospital, Boston, MA, USA. FAU - Makhema, Joseph AU - Makhema J AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. FAU - Shapiro, Roger L AU - Shapiro RL AD - Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. AD - Department of Immunology and Infectious Diseases, Harvard T.H Chan School of Public Health, Boston, MA, USA. LA - eng GR - K24 AI131924/AI/NIAID NIH HHS/United States GR - K24 AI131928/AI/NIAID NIH HHS/United States GR - U01 AI114235/AI/NIAID NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - Switzerland TA - J Int AIDS Soc JT - Journal of the International AIDS Society JID - 101478566 SB - IM MH - Adult MH - Botswana MH - Dried Blood Spot Testing MH - Female MH - HIV Infections/*diagnosis/*transmission MH - Humans MH - *Infant, Newborn MH - *Infectious Disease Transmission, Vertical MH - Pregnancy MH - Pregnancy Complications, Infectious MH - Risk PMC - PMC5980617 OTO - NOTNLM OT - HIV OT - children OT - mother-to-child transmission OT - paediatrics OT - vertical transmission OT - viral suppression EDAT- 2018/06/01 06:00 MHDA- 2019/05/14 06:00 PMCR- 2018/05/29 CRDT- 2018/06/01 06:00 PHST- 2017/11/30 00:00 [received] PHST- 2018/04/16 00:00 [accepted] PHST- 2018/06/01 06:00 [entrez] PHST- 2018/06/01 06:00 [pubmed] PHST- 2019/05/14 06:00 [medline] PHST- 2018/05/29 00:00 [pmc-release] AID - JIA225111 [pii] AID - 10.1002/jia2.25111 [doi] PST - ppublish SO - J Int AIDS Soc. 2018 May;21(5):e25111. doi: 10.1002/jia2.25111.