Is early HIV testing of infants in poorly resourced prevention of mother to child transmission programmes unaffordable?

OBJECTIVES Paediatric HIV infection is predominantly vertically transmitted and 90% of the global burden is carried by Sub Saharan Africa. Diagnosis of HIV infection is important to ensure access to appropriate healthcare. Prevention of mother to child transmission (PMTCT) programmes in low resource settings fail to identify HIV-infected children because of high lost to follow-up rates by 12 months of age when HIV testing is performed. The cost of diagnosing HIV infection earlier in infancy was measured. METHODS A prospective, longitudinal, descriptive study was conducted in a PMTCT clinic in Johannesburg, South Africa over an 18-month period. From a total of 300 HIV exposed infants enrolled in an infant diagnostic study, a convenience sample of 30 was enrolled in a costing sub-study. Patient and provider costs incurred in establishing the HIV status of an exposed infant were documented to determine the societal and provider cost of performing HIV testing at 6 weeks and 12 months of age. RESULTS The average societal cost of an earlier diagnosis of HIV is R158 less per patient than current practice as determined from 123 (82%) questionnaires. On average, early diagnosis would cost the provider R8 more per patient. PMTCT clinic attendance figures predict that earlier testing would increase the number of infants diagnosed by almost threefold. CONCLUSIONS A marginal additional investment by government to access an earlier HIV diagnosis for infants could triple the efficacy of PMTCT programmes in identifying HIV-infected children for medical management and improved quality and quantity of life. Early diagnosis offers societal benefits that extend beyond economic savings.