144. Laboratory Monitoring and Virologic Suppression after Down Referral of Paediatric HIV Patients to Local Clinics in KwaZulu-Natal, South Africa
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall
  • HIV_down-referral_IDSA_2016.pdf (173.0 kB)
  • Background: 

    The South Africa province of KwaZulu-Natal (KZN) has a large burden of human immunodeficiency virus (HIV) disease. Guidelines are in place for diagnosis, treatment, and monitoring of HIV in paediatric patients, but how consistently these guidelines are followed is not known.

    There has been an attempt to de-centralize HIV care as a means to improve antiretroviral (ARV) coverage and adherence. However, the effectiveness of local clinic-based paediatric HIV treatment in KZN is unknown. Additionally, there have been no studies evaluating the outcomes of virologically suppressed patients who are down referred from regional to local clinics in KZN or in other provinces of South Africa.

    We evaluated adherence to guidelines for laboratory follow-up of paediatric HIV patients, and assessed maintenance of virologic suppression after down referral from a regional to local clinics.


    Subjects were 266 children seen in the HIV clinic of a large regional hospital who were down referred to a local clinic after demonstrating virologic response to ARVs.

    The National Health Laboratory System was queried to determine whether viral load (VL) was obtained ~12 months after down referral. Additionally, persistence of virologic response to antiretroviral medications was evaluated.


    Only 73% (194/266) had a VL obtained at ~12 months. Of those with a VL, 19% (37) were no longer virologically suppressed. The percentage of those with reversion to virus detection could have ranged from 14% (if all with unknown VL [n=72] remained suppressed) to 41% (if all with unknown VL were no longer suppressed).


    Adherence to guidelines for laboratory monitoring of paediatric HIV patients in KZN, South Africa is less than optimum. Additionally, virologic suppression did not persist in 19% of those with documented VL, with this reversion to virologic detection potentially being as great at 41% of down referred patients. Evaluation of guideline adherence and VL response in patients who remain within a central/regional clinic is ongoing. Additionally, current work is focusing on factors (clinic and patient characteristics) associated with lack of guideline adherence and reversion to virus detection in an attempt to devise potential strategies for intervention.

    Kevin Spicer, MD, PhD1,2 and Malini Krishna, MBBS2, (1)Pediatrics, University of Oklahoma/Children's Hospital at OU Medical Center, Oklahoma City, OK, (2)Paediatrics, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa


    K. Spicer, None

    M. Krishna, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.