Birth HIV testing found 14 infections; 56 initial positives did not confirm

Across 35 Botswana facilities, targeted birth testing reached 2,627 of 8,844 HIV-exposed newborns, confirmed 14 infections, and started treatment at a median 2.7 days. Yet 56 initial positives did not confirm, 15.4% of birth-negative infants lacked documented 6-week testing, and low-risk newborns were not tested at birth. The cohort supports a confirmatory diagnostic pathway—not a true programme-sensitivity estimate or a simpler-prophylaxis rule.

THE HOT TAKE

Targeted birth testing made 14 diagnoses early. The sharper lesson is that 56 other initial positives needed confirmation—and the untested denominator still matters.

Ajibola and colleagues prospectively embedded risk-stratified HIV testing at birth across 35 Botswana delivery facilities from July 2022 to July 2024. Eligible infants weighed at least 1.5 kg, were born to mothers aged at least 18 years living with HIV, and had a prespecified or staff-identified transmission risk. Infants with a severe condition judged unlikely to survive to 24 months were excluded.

Among 8,844 newborns delivered to women living with HIV, staff flagged 2,737 for birth testing and 2,627 were tested: 1,234 in the prespecified high-risk stratum and 1,393 in a moderate-risk stratum. Fourteen infections were confirmed at birth—13 in the high-risk group and one in the moderate-risk group. The chart shows counts, not sensitivity, and the group denominators differ.