An Audit of Early Infant HIV Diagnosis and Protocol at Wesley Guild Hospital and Its Cost Effectiveness.

Abstract

Background: The human immunodeficiency virus (HIV) screening protocol for high and low risk for HIV transmission exposed infants needs appraisal.

Objective: To audit the cost effectiveness of the early HIV infant diagnosis protocol, by the 2020 (recent) and 2016 (previous) Nigerian guidelines screening protocol.

Methods: All babies delivered by HIV infected mothers over 4years at the Wesley Guild Hospital, Ilesa were studied. Their HIV status, risk category and age at early infant diagnosis were analyzed.

Results: Seventy-two infants and their mother were studied. Thirteen (18.1%) of the total 72 studied were HIV infected. All HIV infections were in the 21 high risk category compared to none in the 51 low risk category (P <0.01). Fifty (98.0%) low risk infants had HIV DNA Polymerase chain reaction (PCR) testing between 6 -8 weeks compared to one (4.5%) high risk between 6-8weeks. (P <0.01). The 21 (95.5%) high risk infants had their first PCR screening between 3 and 14 months. Rapid screening was conducted at 18months for all the 67 infants that survived till this age. The calculated screening cost by the current protocol is thrice as expensive, but equally sensitive for diagnosis as the year 2016 National screening protocol, for low-risk category infants. More than 95% of infants were well immunized and stopped breast feeding at 12 months.

Conclusion: The year 2016 HIV screening protocol is cost effective and should be adopted for screening infants at low risk of HIV acquisition. Significantly higher rates of infection occur in the high-risk category at unknown times, thus necessitating very early screening. Rescheduling of the 9th month rapid screening to coincide with MMR vaccination at 15months is advised to allow for cessation of HIV exposure following breast feeding termination at 12 months.