Removing barriers to children’s healthcare in Papua New Guinea through point-of-care HIV viral load testing

Papua New Guinea has the highest rate of HIV in the Pacific region and is one of only four countries in the Asia-Pacific region whose incidence has increased in the last decade.

Like many resource limited settings, ensuring equitable and timely access to testing and treatment can be challenging.

That includes among newborn children. While medication exists that can prevent mothers with HIV from passing it on to their child in-utero, as is commonly prescribed in countries such as Australia, Papua New Guinea’s mother-to-child transmission rate remains concerningly high, about 25 per cent.[1]

Without diagnosis and effective treatment, more than one-half of HIV-infected infants will die within their first two years.[2]

Early and accurate HIV testing is therefore essential. Once diagnosed with HIV, children and infants require regular HIV viral testing to assess their medication’s efficacy.

However, the only option currently approved for point-of-care HIV viral load testing in Papua New Guinea requires five millilitres of whole blood, which is not recommended for children younger than 10.

Mitchell Starr, a senior hospital scientist at the St Vincent’s Centre for Applied Medical Research, said extracting the necessary blood is traumatic for children and parents, and that that volume of blood is not recommended.

“If parents think it is an awful experience that they don’t want to see their child go through, it becomes a barrier to stepping through the door in the first place. People slip through the healthcare cracks, which equals bad health outcomes for children,” Mr Starr said.

The remoteness of some areas of Papua New Guinea means transporting blood samples to the capital, Port Moresby, to provide paediatric HIV viral load testing using dried blood spots. This can prove logistically difficult, with exceedingly long turnaround times for results, forcing some families to endure repeat long transits - another barrier that may discourage them from seeking care.

With the goal of supporting public health responses for children living with HIV in resource limited settings, such as Papua New Guinea, Abbott has developed a point-of-care viral load test that can be easily transported and administered. Crucially, it provides a result in about an hour.

Using a capillary finger stick, the m-PIMA HIV-1/2 VL assay requires the extraction of just 300 microlitres of whole blood. It is then reduced to 50 microlitres of plasma for testing. This is significantly less than other platforms currently used in Papua New Guinea to perform point-of-care viral load testing, and which cannot serve children less than 10 years of age.

An independent team led by St Vincent’s recently assessed the accuracy of Abbott’s m-PIMA rapid testing instrument. It found a strong positive correlation to a reference test using a typical lab method.

“The whole idea is it can be portable, which is really important for a country like Papua New Guinea. But it is also highly transferable to other settings, particularly low to middle income countries,” Mr Starr said.

A team comprising experts from UNSW Sydney’s Kirby Institute and Abbott representatives has travelled to Papua New Guinea to work with colleagues from the Papua New Guinea Institute of Medical Research to establish m-PIMA HIV viral load testing at point-of-care for infants and children less than 10 years in the Port Moresby General Hospital and the Mount Hagen Provincial Hospital. This work is part of ACTUP, an initiative funded by the Australian Department of Foreign Affairs and Trade (DFAT) to expand HIV viral load testing in Papua New Guinea.

For Kirby Institutes’ Scientia Associate Professor Angela Kelly-Hanku, the ability to offer point-of-care HIV viral load testing for children and infants is about equity; “We want to ensure that the smallest people with HIV in Papua New Guinea have equal access to the same clinical monitoring as older children and adults,” she commented.

An intensive training course was held to instruct local clinicians on how to operate the m-PIMA tests. This approach will help develop a new path of care for children with HIV and their parents. Early results suggest families are happy to be able to know the HIV viral load status of their children

“Hopefully the m-PIMA can change paediatric HIV care so that parents can come to know their children’s results and walk out with all the information they need,” Mr Starr said.

“There was this huge public health need to monitor children and the m-PIMA is the first in the race to fill that gap, which is really important.”

The m-PIMA Analyser and m-PIMA HIV-1/2 Viral Load test are for investigational use only in Australia.