REVIEW

CURRENT
OPINION Early infant diagnosis of HIV: review of current and
innovative practices
Francesca Celletti a,b, Gayle Sherman c,d, and Ahmad H. Mazanderani c,e

Purpose of review
Only 51% of HIV-exposed infants receive an HIV test between 4 and 6 weeks of age, with even lower
repeat testing rates at older ages, and only 49% of infants tested are initiated on antiretroviral therapy. The
purpose of this article is to discuss potential solutions for increasing coverage of early infant diagnosis
(EID), decreasing turnaround time for result return, improving linkages to care and treatment and fulfilling
the objective of improving outcomes for HIV-infected children.
Recent findings
Differences in HIV testing guidelines have emerged in different countries, with some recommending HIV
testing at birth. Although EID programs are not yet optimal, some solutions have proven successful
including the use of short message service printers, community-based interventions and support and
education of mothers. Birth and EID point-of-care testing have emerged as potential game changers for
improving EID programs.
Summary
For EID programs to impact on child health outcomes, by preventing HIV-associated morbidity and
mortality, and provide more value than a mere surveillance tool, efforts need to be aligned toward the
implementation of a comprehensive set of interventions that take cognizance of different contexts,
epidemiology and health systems, and that are backed by political and community support.
Keywords
birth testing, early infant diagnosis, pediatric HIV, point-of-care early infant diagnosis

INTRODUCTION way and timing of HIV testing to prevent HIV-associ-

&

In 2015, Cuba became the first country to meet WHO
validation criteria for the elimination of mother-to-
&
child transmission [1 ], followed by Thailand, Belarus
& EARLY INFANT DIAGNOSIS POLICY
and Armenia in the following year [2 ]. These
achievements signal great strides toward curbing
the global incidence of HIV-infection among infants,
with the annual number of new infections among
children having reduced by 70% since 2000 [3 ].
&
Nevertheless, renewed commitment will be required,
particularly within high-burden settings, if more
countries are to meet the set impact targets of 50
or less new pediatric HIV infections per 100 000 live
births and a less than 5% transmission rate in breast-
feeding populations (<2% in nonbreastfeeding
& Witwatersrand, Johannesburg and eDepartment of Medical Virology,
populations) [4 ]. Furthermore, if early infant diag-
nosis (EID) programs are to impact on child health
outcomes and provide more value than merely a
surveillance tool, efforts need to be focused toward
timely linkage to care and initiation of antiretroviral
therapy amongst those infants who test HIV-positive.
Hence, questions remain regarding the optimal
ated morbidity and mortality [5 ].
GUIDELINES
Requirements to diagnose HIV during infancy differ
from standard testing methods used for adults and
children aged more than 18 months due to the
passive transfer of maternal antibodies. For this
a
Elizabeth Glaser Pediatric AIDS Foundation, Geneva 2, bGeneva
School of Diplomacy, Geneva, Switzerland, cCentre for HIV & STI,
National Institute for Communicable Diseases, dDepartment of Paedi-
atrics and Child Health, Faculty of Health Sciences, University of the
Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Correspondence to Francesca Celletti, MD, PhD, 904 Caribbean Drive,
Sunnyvale, CA 94089, USA. Tel: +1 408 541 4191;
fax: +1 408 541 4192; e-mail: fcelletti@pedaids.org or
francesca.celletti@gmail.com
Curr Opin HIV AIDS 2017, 12:112–116
DOI:10.1097/COH.0000000000000343

www.co-hivandaids.com Volume 12  Number 2  March 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.


KEY POINTS
 Differences in HIV testing guidelines for infants exist in
different countries.
 Some solutions exist to improve EID programs: SMS
printers, community-based interventions and support
and education of mothers.
 Birth and EID point-of-care (POC) testing have emerged
as potential game changers for improving
EID programs.
 For EID programs to impact on child health outcomes,
efforts need to be aligned toward the implementation of
a comprehensive set of interventions that take
cognizance of different contexts, epidemiology and
health systems, and that are backed by political and
community support.
reason, WHO recommends virological methods that
directly detect HIV-1 DNA and/or RNA, such as PCR
&
testing [6 ]. Testing at 4–6 weeks of age, or at the
earliest opportunity thereafter, has been recom-
mended by WHO as a means of deploying a testing
strategy at a single time point that can successfully
detect both intrauterine and intrapartum infections,
thereby facilitating early diagnosis of HIV and
&
initiation of therapy [6 ]. This has further advantage
as it coincides with routine clinic visits within immu-
nization programs, thereby assisting good EID cover-
age and follow-up. However, on account of differing
programmatic opportunities and challenges, as well
as access to resources, multiple variations of the EID
testing timeline have emerged within different
health settings. For example, although US guidelines
recommend virological testing for all HIV-exposed
infants at 14–21 days, 1–2 months and 4–6 months
&
of age [7 ], EID guidelines in Thailand recommend
&
routine testing at 1 and 2–4 months of age [8 ] and
European guidelines recommend testing at birth and,
in the absence of breastfeeding, at least two negative
virological tests 2 and 6 weeks after infant prophy-
laxis is discontinued to establish an HIV-uninfected
&
status [9 ]. Further differences have emerged regard-
ing the classification and time of testing amongst
HIV-exposed infants considered at high risk of peri-
natal transmission, with some countries recom-
mending birth testing.
Although in the pre-antiretroviral therapy (ART)
era intrapartum infections accounted for the
majority of early infant transmission, recent findings
suggest that, within the context of effective preven-
tion of mother to child transmission, intrauterine
infections outnumber intrapartum infections by up
& &&
to three to one [10 ,11 ]. As intrauterine-infected
neonates have a more rapid disease progression and a
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Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Early infant diagnosis of HIV Celletti et al.
two-fold higher risk of mortality than postnatal-
infected neonates, there is concern that waiting to
test after the neonatal period may result in missed
& &
diagnostic and therapeutic opportunities [12 ,13 ].
This is further supported by findings that early
initiation of treatment significantly reduces HIV-
associated morbidity and mortality and that infants
who test positive at 6 weeks of age are only linked to
care and initiated on treatment after the described
&& &
peak mortality rate [14 ,15 ,16 ].
&
GLOBAL STATUS OF EARLY INFANT
DIAGNOSIS
Globally, only 49% of infants are receiving an EID
test by the WHO-recommended 6–8-week window
&
[17 ]. In addition, only a fraction of those infants
tested at 6 weeks are retested at 9 and 18 months to
confirm HIV status, whereas we know that 39% of
HIV infection happens after 6 weeks from birth
&
[18 ]. In the past few years, efforts have been made
to improve the EID coverage rate, including a 30–
60% price reduction for tests and pricing stability
globally since 2007; significant consolidation in
procurement from over 50 items to three bundled
products – now regarded as the market standard; an
increase in the number of health facilities accessing
EID from 200 to more than 10 000; and over 1
million EID tests delivered in 2013 without a sig-
nificant increase in new laboratories, enabling a
more than eight-fold increase in the number of
&
children on ART [19 ]. Approximately 50% of
infants who are tested never receive their test results
&
[20 ]. For those who do receive the test results, the
turnaround time between sample collection and the
return of test results can take as long as 30–90 days
&
in sub-Saharan African countries [21 ]. For example,
in Zambia, where 74% of HIV-exposed infants
receive EID, the median time for the return of results
&
to the caregiver in rural areas was 92 days [22 ]. In
Tanzania, where only one in three exposed infants
receive EID, the turnaround time from testing to
delivery of results to caregivers ranged from five to
10 weeks, and only 55% of caregivers returned for
&
results [23 ]. As a result, this ineffective diagnostic
methodology contributes to significant delays in the
diagnosis and treatment cascade. In addition, with-
out treatment, up to 30% of HIV-infected children
die by their first birthday, 50% by their second and
&
68% by their fifth [24 ].
INNOVATIVE SOLUTIONS TO IMPROVE
EARLY INFANT DIAGNOSIS
Several solutions have been implemented in
countries to overcome these issues. For example,
www.co-hivandaids.com 113
HIV and diagnostics
in Kenya, EID results are being transferred by short
message service (SMS) Printers to reduce turnaround
times for transmission of laboratory results from
&
specimen collection to reaching the clinic [25 ].
Again in Kenya, an organized system of delivering
and monitoring community-based interventions
has been put in place and has proven to be critical
in preventing defaults and in tracing infants who are
lost to follow-up [26]. In Nigeria, integration of HIV
and maternal and child services resulted in a sub-
stantial improvement in maternal ART initiation
and mother–infant pair retention in care at 6 and
&
12 weeks postpartum [27 ]. Early, consistent and
repeated messaging about the availability of EID
services is important to increase the timely uptake
&
of EID [28 ]. In addition, it has also been shown that
provider–patient communication and judgment-
free counseling and support for mothers with HIV
can also contribute to increase testing of HIV-
&
exposed infants [28 ]. Strategies for supporting
mothers with less formal education and who live
far from services have also been recommended,
given the higher risk for seeking EID later than 7–
&
12 weeks of age [28 ]. However, more radical inter-
ventions associated with a simpler test reduced turn-
around time, and earlier possibilities of linkages to
care and treatment are currently needed to improve
case findings and initiate treatment before the onset
of HIV-associated morbidity and mortality. This is
the reason point-of-care (POC) EID and birth testing
are currently being considered by countries.
BIRTH TESTING
Testing all HIV-exposed neonates at birth has the
potential to reduce HIV-related infant morbidity
and mortality by facilitating earlier diagnosis of
and ART initiation in HIV-infected neonates. How-
ever, as an intervention, high coverage of birth
testing with successful navigation of the complex-
ities of neonatal ART treatment and retention in
care has to be achieved before improvements in
outcomes of infected infants can be assessed at a
program level.
South Africa introduced routine birth testing
for all HIV-exposed neonates into its EID program
&
in June 2015 [29 ] and represents the first high-
burden country to do so. South Africa’s Guidelines
also recommend a second PCR test at 10 weeks of
age for those neonates who test negative to detect
intrapartum infections, in addition to testing as
&
soon after birth as possible [29 ]. Within 1 year,
national birth testing coverage exceeded 90%, and
the intrauterine infection transmission rate was
1.1%. Considering that the 6-week transmission
rate for 2015 was 1.5%, the transmission rate at
114 www.co-hivandaids.com
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
birth demonstrates that most early infant infec-
&
tions are detectable by birth testing [30 ]. It
remains to be determined what the eventual con-
tribution of universal birth testing will be for rates
of ART initiation, viral suppression and neonatal
and infant mortality.
The South Africa’s birth testing program has
been built upon a strong EID foundation. Despite
a considerable antenatal HIV prevalence of more
than 29%, 20 South Africans had a good reported
EID testing coverage at 6 weeks of more than 80%
& &
[30 –32 ] utilizing nine centralized laboratories that
mostly process dried blood spot samples obtained
from capillary heel-prick. In excess of 80% of HIV
PCR tests have a laboratory turnaround time of less
than 96 h, facilitating early result return and
initiation of antiretroviral treatment. Furthermore,
a single national laboratory information system
throughout the public health sector provides
healthcare workers access to results through the
Internet and via SMS printers, in addition to being
provided article-based results. The majority of births
occur in institutions, and the environment ident-
ifies virtually all HIV-exposed neonates for birth
testing, enabling the rapid scalability of high birth
testing coverage rates.
Nevertheless, introducing birth testing has not
been a simple endeavor. Significant strain has been
placed on already understaffed maternity unit per-
sonnel to upskill them in taking and submitting HIV
PCR specimens, have them perform neonatal HIV
counseling and testing in addition to their other
duties and maintain records for tracing of results
and active tracing of particularly HIV PCR–positive
neonates. Often, research units have assisted routine
services with additional staff to accomplish birth
testing, and despite receiving results within 2–3
days, follow-up of infected neonates has proved
difficult. At first glance, EID POCT appears to be
the solution for identification of HIV-infected neo-
nates before discharge from the delivery unit; how-
ever, the implications for further stressing staff
capacity with having to perform testing, amongst
other tasks required by POCT, require careful con-
sideration. Neonatal treatment of HIV to reduce
morbidity and mortality is the ultimate aim of birth
testing, yet it is complex and has required central-
izing care in units with expertise.
Introduction of birth testing in other high-bur-
den countries is being considered but would require
reviewing outcomes of current EID programs, esti-
mating the local clinical and laboratory capacity to
shoulder the additional burden of birth testing and
calculating the best local testing options for identi-
fying the most HIV-infected infants as early in life
as possible.
Volume 12  Number 2  March 2017

POINT-OF-CARE EARLY INFANT
DIAGNOSIS
To overcome the issues related to early HIV testing
and the return of test results, recently, a new POC
technology that could allow infants to be tested
immediately at birth or later and provides ‘while-
you-wait’ results has recently emerged. Two POC
EID products have made their way onto the market,
whereas others, even more promising, are in the
&& && &
development pipeline [33 ,34 ,35 ]. In managing
HIV/AIDS, POC technology has been used for the
monitoring of CD4þ cell count [36 ]. It has been
&
reported that after the introduction of point-of-care
CD4þ, the proportion of patients lost to follow-up
before completion of CD4þ staging dropped from 57
to 21%. Total loss to follow-up before initiation of
antiretroviral treatment fell from 64 to 33%, and the
proportion of enrolled patients initiating antiretro-
viral therapy increased from 12 to 22% (94 of 437).
The median time from enrolment to antiretroviral
therapy initiation reduced from 48 to 20 days prim-
arily because of a reduction in the median time
taken to complete CD4þ staging, which decreased
&
from 32 to 3 days [30 ]. Use of the POC GenXpert in
the diagnosis and management of tuberculosis has
shown equal or better diagnosis of tuberculosis both
in adults and children but not necessarily better
programmatic results and decrease mortality at 6
&
months [36 ,37 ].
&
With this premise, if strategically introduced
and integrated within the current service delivery
and laboratory networks, POC EID could represent a
game changer both in the diagnosis and treatment
of HIV-infected infants. However, there are a series
of considerations to be made as to maximize the
potential of this novel technology in the elimin-
ation of pediatric HIV by 2020.
Each country context is unique, with different
health systems, epidemics and responses to the
epidemic, and as such there is no uniform approach
to introducing POC EID that will be appropriate for
all settings. However, there are some generic con-
cerns to follow.
First, the introduction of POC EID should have
the primary objective of optimizing but not replac-
ing the current conventional EID network, and it
should be preceded by an assessment of convention-
al EID network in respect of efficiencies, challenges
and gaps of conventional EID with the intention of
optimizing the access, coverage and quality of EID.
This will mean maintaining conventional EID in
facilities well supported by central laboratories, plac-
ing POC EID platforms in central and more periph-
eral facilities with nonideal link to central
laboratories, conducting community-based and
mobile POC EID testing through outreach and
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Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Early infant diagnosis of HIV Celletti et al.
creating networks for sample transport amongst
facilities.
In more specific terms, for the correct placement
of POC EID, consideration of HIV epidemiological
data points, level of the health systems, client volumes
and infrastructure conditions among others is necess-
ary. For the operationalization, it will be important to
conceptualize and design different models for use and
placement, as for example hub and spoke, rotation
within facilities and mobile clinics.
To maximize cost efficiencies and public health
impact, the placement of POC EID platforms and
development of optimal networks will likely be
influenced by the country’s plans to scale up POC
viral load monitoring and multipurpose platform
for the diagnosis of other diseases other than HIV.
This comprehensive approach increases the likeli-
hood of a sustainable market for the platforms, as
EID needs decrease and might prove the potential of
this transformative technology able to fill critical
gaps both on the diagnostic and monitoring side.
Initially, POC might not increase the overall
coverage but start by capturing the current EID mar-
ket while improving the time to results return and
reduce wastage only. It might also allow HIV testing
at birth and possibility of very early treatment
initiation. Because results will be received at the same
clinic visit, time to treatment initiation should be
reduced, and a positive impact on retention and
overall morbidity and mortality is anticipated.
CONCLUSION
There is no ‘one size fits all solution’ for optimizing
EID coverage, increasing the rate of result return
and ensuring linkage to care and treatment for
infants testing HIV-positive. A comprehensive set
of interventions, integrated into national health-
care programs and tailored for conditions specific to
each country’s healthcare system and HIV epi-
demic, should be adopted to improve the entire
pediatric HIV testing and treatment cascade.
Improving identification of HIV-infected infants
needs to be coupled to initiating treatment as early
as possible and retaining children in care until
adolescents are transitioned to adult care and
pediatric AIDS dwindles.
National leaders have a critical role to play in
ensuring that the right solutions are adopted by
their countries to prevent new infections, address
the needs of children living with HIV, align national
approaches with international normative guidance
and ensure preparedness to scale up new technol-
ogies and innovative practices. Finally, it is critical
that the community be fully engaged to ensure
acceptability and uptake of testing. Pregnant
www.co-hivandaids.com 115
HIV and diagnostics
women and mothers living with HIV need to be on
board for transformative solutions to work.
Acknowledgements
None.
Financial support and sponsorship
G.S. has partially been funded by UNICEF and Ahamd
Haeri Mazanderani from Discovery Foundation.
Conflicts of interest
There are no conflicts of interest.
REFERENCES AND RECOMMENDED
READING
Papers of particular interest, published within the annual period of review,
have been highlighted as:
& of special interest
&& of outstanding interest
1. http://www.who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/. 20
& October 2016.
Of special interest as it reports on the first country to achieve EMTCT.
2. http://www.who.int/mediacentre/news/statements/2016/mother-child-hiv-
& syphilis/en/. 20 October 2016.
Of special interest as it reports on the second and third country to achieve EMTCT.
3. UNAIDS. Prevention gap report. Geneva: UNAIDS; 2016.
& 25. CHAI, Kenya; 2015.
Of special interest as it reports on the most recent data on HIV.
4. World Health Organization. Global guidance on criteria and processes for
& validation: elimination of mother-to-child transmission (EMTCT) of HIV and
syphilis. Geneva: WHO; 2014.
Of special interest as it reports on the EMTACT guidelines.
5. Sherman GG. HIV testing during the neonatal period. S Afr J HIV Med 2015;
& 16:1–3.
Of special interest as it reports on first experiences on birth testing.
6. WHO. WHO recommendations on the diagnosis of HIV infection in infants
& and children. Geneva: WHO; 2010.
Of special interest as it reports on diagnosis of HIV infection.
7. Panel on Antiretroviral Therapy and Medical Management of HIV-Infected
& Children. Guidelines for the use of antiretroviral agents in pediatric HIV
infection. Bethesda: National Institutes of Health; 2016.
Of special interest as it reports on EID guidelines in USA.
8. Bamford A1, Turkova A, Lyall H, et al. Paediatric European Network for
& Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1
infection 2015: optimizing health in preparation for adult life. HIV Med 2015;
doi: 10.1111/hiv.12217. [Epub ahead of print]
Of special interest as it reports on EID guidelines in Europe.
9. Lolekha R. Elimination of mother-to-child transmission of HIV – Thailand.
& MMWR Morb Mortal Wkly Rep 2016; 65:562–566.
Of special interest as it reports on EID guidelines in Thailand.
10. Lilian RR, Kalk E, Bhowan K, et al. Early diagnosis of in utero and intrapartum
& HIV infection in infants prior to 6 weeks of age. J Clin Microbiol 2012;
50:2373–2377.
Of special interest as it reports on diagnosis of HIV in utero and postpartum HIV
infection.
11. De Cock KM, Fowler MG, Mercier E, et al. Prevention of mother-to-child HIV
&& transmission in resource-poor countries: translating research into policy and
practice. JAMA 2000; 283:1175–1182.
Of outstanding interest as it reports on translation of research into policy and
practice.
12. Zijenah LS, Moulton LH, Iliff P, et al. Timing of mother-to-child transmission of
& HIV-1 and infant mortality in the first 6 months of life in Harare, Zimbabwe.
AIDS 2004; 18:273–280.
Of special interest as it reports on timing of HIV diagnosis in infants and related
mortality.
13. Marinda E, Humphrey JH, Iliff PJ, et al. Child mortality according to maternal
& and infant HIV status in Zimbabwe. Pediatr Infect Dis J 2007; 26:519–526.
Of special interest as it reports on HIV-related mortality.
14. Lilian RR, Kalk E, Technau K-G, Sherman GG. Birth diagnosis of HIV infection
&& in infants to reduce infant mortality and monitor for elimination of mother-to-
child transmission. Pediatr Infect Dis J 2013; 32:1080–1085.
Of outstanding interest as it reports on first experiences in birth testing.
15. Innes S, Lazarus E, Otwombe K, et al. Early severe HIV disease precedes early
& antiretroviral therapy in infants: are we too late? J Int AIDS Soc 2014;
17:18914.
Of special interest as it reports on timing of ART initiation in HIV-infected infants.
116 www.co-hivandaids.com
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
16. Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality
& among HIV-infected infants. N Engl J Med 2008; 359:2233–2244.
Of special interest as it reports on impact of ART initiation on mortality of HIV-
infected infants.
17. UNAIDS. HIV factsheet. 2015; UNAIDS, Geneva. Switzerland. Available from:
& http://www.unaids.org/sites/default/files/media_asset/20150714_FS_MDG6_
Report_en.pdf. [Cited 6 September 2015]
Of special interest as it reports on HIV data.
18. UNICEF. UNICEF analysis of UNAIDS 2014 HIV and AIDS estimates. New
& York: UNICEF; 2015.
Of special interest as it reports on HIV data.
19. CHAI. UNITAID market forum. 2014; UNITAID, Geneva, Switzerland.
&
Of special interest as it reports on HIV-related products market data.
20. Essajee S, Vojnov L, Penazzato M, et al. Reducing mortality in HIV-infected
& infants and achieving the 90-90-90 target through innovative diagnosis
approaches. J Int AIDS Soc 2015; 18 (7 Suppl 6):20299.
Of special interest as it reports on how new diagnostic approaches can reduce
mortality in HIV-infected infants.
21. Chatterjee A, Tripathi S, Gass R, et al. Implementing services for early infant
& diagnosis (EID) of HIV: a comparative descriptive analysis of national pro-
grams in four countries. BMC Public Health 2011; 11:.
Of special interest as it compares national EID programs in four countries.
22. Sutcliffe C, van Dijk JH, Hamangaba F, et al. Turnaround time for early infant
& HIV diagnosis in rural Zambia: a chart review. PLoS One 2014; 9:e87028.
Of special interest as it reports on turnaround time of HIV test results in infants.
23. Chiduo M, Mmbando BP, Theilgaard ZP, et al. Early infant diagnosis of HIV in
& three regions in Tanzania; successes and challenges. BMC Public Health
2013; 13:910.
Of special interest as it reports on EID programs in Tanzania.
24. Newell ML. Mortality of infected and uninfected infants born to HIV-infected
& mothers in Africa: a pooled analysis. Lancet 2004; 364:1236–1243.
Of special interest as it reports on how new diagnostic approaches can reduce
mortality in HIV-infected infants.
&
Of special interest as it reports on CHAI innovative experience in Kenya.
26. EGPAF, Kenya; 2015.
27. Joseph Davey D, Myer L, Bukusi E, et al. Integrating human immunodeficiency
& virus and reproductive, maternal and child, and tuberculosis health services
within national health systems. Curr HIV/AIDS Rep 2016; 13:170–176.
Of special interest as it reports on impact of integrated service delivery.
28. Merten S, Ntalasha H, Musheke M. Non-uptake of HIV testing in children at
& risk in two urban and rural settings in Zambia: a mixed-methods study. PLoS
One 2016; 11:e0155510.
Of special interest as it reports on reasons for low uptake of HIV testing in infants.
29. National Department of Health. National consolidated guidelines for the
& prevention of mother-to-child transmission of HIV (PMTCT) and the manage-
ment of HIV in children. Adolescents and adults. Pretoria: National Depart-
ment of Health; 2015.
Of special interest as it reports on South Africa national guidelines.
30. Massyn N, Day C, Peer N, et al. District health barometer 2013/14. Durban,
& South Africa: Health System Trust, South Africa; 2014.
Of special interest as it reports on South Africa national processes.
31. National Department of Health. The 2013 national antenatal sentinel HIV
& .prevalence survey South Africa. Pretoria: National Department of Health; 2015
Of special interest as it reports on South Africa national guidelines.
32. Sherman GG, Lilian RR, Bhardwaj S, et al. Laboratory information system data
& demonstrate successful implementation of the prevention of mother-to-child trans-
mission programme in South Africa. S Afr Med J 2014; 104 (3 Suppl 1):235–238.
Of special interest as it reports on importance on laboratory information systems.
33. Jani IV, Meggi B, Mabunda N, et al. Accurate early infant HIV diagnosis in
&& primary health clinics using a point-of-care nucleic acid test. J Acquir Immune
Defic Syndr 2014; 67:e1–e4.
Of outstanding interest as it reports on early experience with POC EID.
34. Point of care early infant HIV diagnosis in South Africa [CROI Abstract 34]. In
&& Special Issue: Abstracts From the 2015 Conference on Retroviruses and
Opportunistic Infections. Top Antivir Med. 2015; 23:15.
Of outstanding interest as it reports on early experience with POC EID in the
diagnosis of HIV.
35. Hsiao NY, Dunning L, Kroon M, Myer L. Laboratory evaluation of the Alere q point-
& of-care system for early Infant HIV diagnosis. PLoS One 2016; 11:e0152672.
Of special interest as it reports on early experience with POC EID in the diagnosis
of HIV.
36. Churchyard GJ, Stevens WS, Mametja LD, et al. Xpert MTB/RIF versus
& sputum microscopy as the initial diagnostic test for tuberculosis: a cluster-
randomised trial embedded in South African roll-out of Xpert MTB/RIF. Lancet
Glob Health 2015; 3:e450–e457.
Of special interest as it reports on early experience with POC EID in diagnosis of
tuberculosis.
37. Detjen AK, DiNardo AR, Leyden J, et al. Xpert MTB/RIF assay for the diagnosis
& of pulmonary tuberculosis in children: a systematic review and meta-analysis.
Lancet Respir Med Jun 2015; 3:451–461.
Of special interest as it reports on early experience with POC EID in diagnosis of
tuberculosis.
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