Delays in HIV-1 infant PCR testing may leave children without confirmed diagnoses

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Stellenbosch : Stellenbosch University
Background The early diagnosis and confirmation of HIV infection in newborns is crucial for expedited antiretroviral therapy initiation. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and rejection of HIV PCR test requests at National Health Laboratory Service laboratories. Aim and objectives To assess relevant measures for routine infant HIV PCR testing: rate of rejected test requests, turnaround time, and rate of confirmatory testing. Method A retrospective review was performed on the laboratory-based data of all HIV PCR tests that were performed on children ≤24 months old (n=43,346), and data of rejected HIV PCR requests (n=1,479) over a two-year period (2017-2019). These data were extracted from the laboratory information system. Data were analyzed from sample collection to release of results, assessing the TAT and follow-up patterns. Results The proportion of HIV PCR requests that were rejected was 3.3%, of which 83.9% were rejected for various pre-analytical reasons. The majority of test results (89.2%) met the required 96-hour TAT. Of the reactive initial test results, 53.5% had a follow-up sample sent, of which 93.1% were positive on follow-up. Of the initial indeterminate results, 74.7% were negative on follow-up. Conclusion A significant proportion of HIV PCR requests were rejected for various pre-analytical reasons. The high number of initial reactive tests, without evidence of follow-up, may suggest that a shorter TAT would be required to allow confirmatory testing, before children are discharged.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
Thesis (MMed)--Stellenbosch University, 2021.
HIV -- Infant -- Diagnosis, UCTD, HIV-positive children, Antiretroviral drugs, Diagnosis, Laboratory, Polymerase chain reaction -- Diagnostic use