Observational studyThe lancet. HIV2018
12-month outcomes of HIV-infected infants identified at birth at one maternity site in Johannesburg, South Africa: an observational cohort study.
Observational study in The lancet. HIV, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Characterizing the HIV care continuum among children and adolescents with HIV in eastern and southern Africa in the era of "Universal Test and Treat": A systematic review and meta-analysis.Journal of the International AIDS Society · 2025Pooled it
- Impact of Point-of-Care Birth Test-and-Treat on Clinical Outcomes Among Infants With HIV: A Cluster-Randomized Trial in Mozambique and Tanzania.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Twice-Daily Dosing of Dolutegravir in Infants on Rifampicin Treatment: A Pharmacokinetic Substudy of the EMPIRICAL Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Trial
- High Viral Suppression Rates and Attrition Rates Among Children With Perinatally Acquired HIV in the Thai National AIDS Program, 2023.The Pediatric infectious disease journal · 2026Article
- Uptake and Timing of Viral Load Testing and Frequency of Viraemic Episodes During Pregnancy in South Africa.HIV/AIDS (Auckland, N.Z.) · 2026Article
- Optimising Paediatric HIV Treatment: Recent Developments and Future Directions.Paediatric drugs · 2024Review
- Cohort profile: Rahima Moosa Mother and Child Hospital maternal HIV cohort, Johannesburg, South Africa.BMJ open · 2024Article
- High mortality following early initiation of antiretroviral therapy in infants living with HIV from three African countries.EClinicalMedicine · 2024Article
- Retention in care of infants diagnosed with HIV at birth: Beyond the diagnostic strategy.Southern African journal of infectious diseases · 2024Article
- Abacavir safety and effectiveness in young infants with HIV in South African observational cohorts.Antiviral therapy · 2023Observational
- Immune correlates of HIV-1 reservoir cell decline in early-treated infants.Cell reports · 2022Article
- Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research.Implementation science communications · 2021Article
- Second-generation mother-to-child HIV transmission in South Africa is characterized by poor outcomes.AIDS (London, England) · 2021Observational
- Birth Testing for Infant HIV Diagnosis in Eswatini: Implementation Experience and Uptake Among Women Living With HIV in Manzini Region.The Pediatric infectious disease journal · 2020Article
- HIGH-FREQUENCY failure of combination antiretroviral therapy in paediatric HIV infection is associated with unmet maternal needs causing maternal NON-ADHERENCE.EClinicalMedicine · 2020Article
- Sex-specific innate immune selection of HIV-1 in utero is associated with increased female susceptibility to infection.Nature communications · 2020Article
- Point-of-care HIV maternal viral load and early infant diagnosis testing around time of delivery at tertiary obstetric units in South Africa: a prospective study of coverage, results return and turn-around times.Journal of the International AIDS Society · 2020Article
- Earlier Antiretroviral Therapy Initiation and Decreasing Mortality Among HIV-infected Infants Initiating Antiretroviral Therapy Within 3 Months of Age in South Africa, 2006-2017.The Pediatric infectious disease journal · 2020Article
- Impact of routine birth early infant diagnosis on neonatal HIV treatment cascade in eThekwini district, South Africa.Southern African journal of HIV medicine · 2020Article
- Reduced Time to Suppression Among Neonates With HIV Initiating Antiretroviral Therapy Within 7 Days After Birth.Journal of acquired immune deficiency syndromes (1999) · 2019Article
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Authors and funding
12 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundInitiation of antiretroviral therapy (ART) following diagnosis of HIV infection at birth is an emerging area of paediatric HIV care. We present outcomes of HIV-infected infants identified at birth at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa.
methodsFrom September, 2013 (era 1), only high-risk HIV-exposed infants were offered diagnostic HIV PCR tests at birth. From June, 2014 (era 2), all HIV-exposed infants were offered laboratory-based diagnostic PCR tests. From October, 2014 (era 3), point of care (POC) diagnostic PCR tests were also done if staff availability allowed. We describe time to ART initiation, mortality, retention in care, and viral suppression among the HIV-infected infants identified across these eras.
findingsWe tested 5449 HIV-exposed infants who were born between Sept 1, 2013, and June 30, 2016. 88 neonates with confirmed HIV infection were identified and included in the study, of which 86 (98%) started ART. Median age at ART initiation decreased from 9 days (IQR 6-25) in eras 1 and 2 to 2 days (1-8) in era 3. In era 3, more neonates who were co-tested with POC testing started ART within 48 h of birth (29 [83%] of 35; median 1 day [IQR 1-2]) than infants who were not co-tested (one [4%] of 29; median 6 days [5-10]). The probability of mortality by 12 months across the eras was 14% (95% CI 8-24) and did not differ by era. Of the 72 infants who survived and initiated ART at the site, 56 (78%) were retained at 12 months. Of the 56 infants retained in care, 40 (71%) had a viral load less than 400 copies per mL at 12 months, with no differences between eras (p=0·23).
interpretationHIV-infected infants can be identified at birth and ART can be initiated within hours to days. Although most infants in our cohort started ART, mortality remained unacceptably high with suboptimal retention and viral suppression. Reducing mortality and improving retention and viral suppression remain urgent priorities.
fundingEunice Kennedy Shriver National Institute of Child Health and Human Development/National Institute of Allergy and Infectious Disease, National Institutes of Health, USAID/PEPfAR, and the South African National HIV Programme.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.