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Nkenfou CN, Nguefack-Tsague G, Nanfack AJ, Moudourou SA, Ngoufack MN, Yatchou LG, Elong EL, Kameni JJ, Tiga A, Kamgaing R, Kamgaing N, Fokam J, Ndjolo A. Strategic HIV Case Findings among Infants at Different Entry Points of Health Facilities in Cameroon: Optimizing the Elimination of Mother-To-Child Transmission in Low- and- Middle-Income Countries. Viruses 2024; 16:752. [PMID: 38793633 PMCID: PMC11125675 DOI: 10.3390/v16050752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought to determine HIV positivity rates among children according to entry points in Cameroon. METHODS A facility-based survey was conducted from January 2015 to December 2019 among mother-child couples at various entry points of health facilities in six regions of Cameroon. A questionnaire was administered to parents/guardians. Children were tested by polymerase chain reaction (PCR). Positivity rates were compared between entry points. Associations were quantified using the unadjusted positivity ratio (PR) for univariate analyses and the adjusted positivity ratio (aPR) for multiple Poisson regression analyses with 95% confidence intervals (CIs). p-values < 0.05 were considered significant. RESULTS Overall, 24,097 children were enrolled. Among them, 75.91% were tested through the HIV prevention of mother-to-child transmission (PMTCT) program, followed by outpatient (13.27%) and immunization (6.27%) services. In total, PMTCT, immunization, and outpatient services accounted for 95.39% of children. The overall positivity was 5.71%, with significant differences (p < 0.001) between entry points. Univariate analysis showed that inpatient service (PR = 1.45; 95% CI: [1.08, 1.94]; p = 0.014), infant welfare (PR = 0.43; 95% CI: [0.28, 0.66]; p < 0.001), immunization (PR = 0.56; 95% CI: [0.45, 0.70]; p < 0.001), and PMTCT (PR = 0.41; 95% CI: [0.37, 0.46]; p < 0.001) were associated with HIV transmission. After adjusting for other covariates, only PMTCT was associated with transmission (aPR = 0.66; 95% CI: [0.51, 0.86]; p = 0.002). CONCLUSIONS While PMTCT accounts for most tested children, high HIV positivity rates were found among children presenting at inpatient, nutrition, and outpatient services and HIV care units. Thus, systematic HIV testing should be proposed for all sick children presenting at the hospital who have escaped the PMTCT cascade.
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Affiliation(s)
- Celine Nguefeu Nkenfou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Higher Teacher Training College, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon
| | - Georges Nguefack-Tsague
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
| | - Aubin Joseph Nanfack
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Sylvie Agnes Moudourou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | | | - Leaticia-Grace Yatchou
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Elise Lobe Elong
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Joel-Josephine Kameni
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Aline Tiga
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Rachel Kamgaing
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
| | - Nelly Kamgaing
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
- Faculty of Health Sciences, University of Buea, Buea P.O. Box 63, Cameroon
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon; (A.J.N.); (S.A.M.); (L.-G.Y.); (E.L.E.); (J.-J.K.); (A.T.); (R.K.); (N.K.); (A.N.)
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé P.O. Box 3077, Cameroon;
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Yumo H, Nsame D, Kuwoh P, Njabon M, Sieleunou I, Ndenkeh J, Tene G, Memiah P, Kuaban C, Beissner M. Implementation of blanket provider-initiated testing and counselling: Predictors of HIV seropositivity among infants, children and adolescents in Cameroon. PUBLIC HEALTH IN PRACTICE 2020; 1:100025. [PMID: 36101680 PMCID: PMC9461293 DOI: 10.1016/j.puhip.2020.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Study design Methods Results Conclusions Methods to increase the yield of PITC remain unclear. HIV seropositivity predictors could improve PITC yield. Identifying HIV seropositivity predictors among children and adolescents. Targeted HIV testing to improve PITC yield in HIV high burden countries. HIV seropositivity predictors could reduce gap in pediatric and adolescent ART.
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Affiliation(s)
- H.A. Yumo
- Research for Development International (R4D International), Yaoundé, Cameroon
- Center for International Health (CIH), Ludwig-Maximilians-University, Munich, Germany
- Corresponding author. R4D International, Opposite Fokou Mendong, PO.BoX: 30883, Yaounde, Cameroon.
| | - D.N. Nsame
- Abong-Mbang District Hospital, Abong-Mbang, Cameroon
- Limbe Regional Hospital, Limbe, Cameroon
| | - P.B. Kuwoh
- Limbe Regional Hospital, Limbe, Cameroon
| | | | - I. Sieleunou
- Research for Development International (R4D International), Yaoundé, Cameroon
- School of Public Health, University of Montreal, Montreal, Canada
| | - J.J.N. Ndenkeh
- Research for Development International (R4D International), Yaoundé, Cameroon
- Center for International Health (CIH), Ludwig-Maximilians-University, Munich, Germany
| | - G. Tene
- Research for Development International (R4D International), Yaoundé, Cameroon
| | - P. Memiah
- Division of Epidemiology and Prevention, University of Maryland School of Medicine, Baltimore, USA
| | - C. Kuaban
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - M. Beissner
- Center for International Health (CIH), Ludwig-Maximilians-University, Munich, Germany
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3
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Kiyaga C, Urick B, Fong Y, Okiira C, Nabukeera-Barungi N, Nansera D, Ochola E, Nteziyaremye J, Bigira V, Ssewanyana I, Olupot-Olupot P, Peter T, Ghadrshenas A, Vojnov L. Where have all the children gone? High HIV prevalence in infants attending nutrition and inpatient entry points. J Int AIDS Soc 2019; 21. [PMID: 29479861 PMCID: PMC6426069 DOI: 10.1002/jia2.25089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 02/08/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Despite notable progress towards PMTCT, only 50% of HIV‐exposed infants in sub‐Saharan Africa were tested within the first 2 months of life and only 30% of HIV‐infected infants are on antiretroviral treatment. This study assessed HIV prevalence in infants and children receiving care at various service entry points in primary healthcare facilities in Uganda. Methods A total of 3600 infants up to 24 months of age were systematically enrolled and tested at four regional hospitals across Uganda. Six hundred infants were included and tested from six facility entry points: PMTCT, immunization, inpatient, nutrition, outpatient and community outreach services. Findings The traditional EID entry point, PMTCT, had a prevalence of 3.8%, representing 19.6% of the total HIV‐positive infants identified in the study. Fifty percent of the 117 identified HIV‐positive infants were found in the nutrition wards, which had a prevalence of 9.8% (p < 0.001 compared to PMTCT). Inpatient wards had a prevalence of 3.5% and yielded 17.9% of the HIV‐positive infants identified. Infants tested at immunization wards and through outreach services identified 0.8% and 1.7% of the HIV‐positive infants respectively, and had a prevalence of less than 0.3%. Conclusions Expanding routine early infant diagnosis screening beyond the traditional PMTCT setting to nutrition and inpatient entry points will increase the identification of HIV‐infected infants. Careful reflection for appropriate testing strategies, such as maternal re‐testing to identify new HIV infections and HIV‐exposed infants in need of follow‐up testing and care, at immunization and outreach services should be considered given the expectedly low prevalence rates. These findings may help HIV care programmes significantly expand testing to improve access to early infant diagnosis and paediatric treatment.
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Affiliation(s)
| | | | - Youyi Fong
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - Emmanuel Ochola
- Department of HIV, Research and Documentation, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Julius Nteziyaremye
- Department of Paediatrics/Research Unit, Mbale Regional Referral Hospital, Busitema University, Mbale, Uganda
| | | | | | - Peter Olupot-Olupot
- Department of Paediatrics/Research Unit, Mbale Regional Referral Hospital, Busitema University, Mbale, Uganda
| | - Trevor Peter
- Clinton Health Access Initiative, Kampala, Uganda
| | | | - Lara Vojnov
- Clinton Health Access Initiative, Kampala, Uganda
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Yumo HA, Ajeh RA, Beissner M, Ndenkeh JN, Sieleunou I, Jordan MR, Sam-Agudu NA, Kuaban C. Effectiveness of symptom-based diagnostic HIV testing versus targeted and blanket provider-initiated testing and counseling among children and adolescents in Cameroon. PLoS One 2019; 14:e0214251. [PMID: 31059507 PMCID: PMC6502453 DOI: 10.1371/journal.pone.0214251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives The concurrent implementation of targeted (tPITC) and blanket provider-initiated testing and counselling (bPITC) is recommended by the World Health Organization (WHO) for HIV case-finding in generalized HIV epidemics. This study assessed the effectiveness of this intervention compared to symptom-based diagnostic HIV testing (DHT) in terms of HIV testing uptake, case detection and antiretroviral therapy (ART) enrollment among children and adolescents in Cameroon, where estimated HIV prevalence is relatively low at 3.7%. Methods In three hospitals where DHT was the standard practice before, tPITC and bPITC were implemented by inviting HIV-positive parents in care at the ART clinics to have their biological children (6 weeks-19 years) tested for HIV (tPITC). Concurrently, at the outpatient departments, similarly-age children/adolescents were systematically offered HIV testing via accompanying parents/guardians. The mean monthly number of children tested for HIV, identified HIV-positive and ART-enrolled were used to compare the outcomes of different HIV testing strategies before and after the intervention. Results In comparing DHT to bPITC, there was a significant increase in the mean monthly number of children/adolescents tested for HIV (223.0 vs 348.3, p = 0.0073), but with no significant increase in the mean monthly number of children/adolescents: testing HIV-positive (10.5 vs 9.7, p = 0.7574) and ART- enrolled (7.3 vs 6.3, p = 0.5819). In comparing DHT to tPITC, there was no significant difference in the mean monthly number of children/adolescents: tested for HIV (223 vs 193.8, p = 0.4648); tested HIV-positive (10.5 vs 10.6, p = 0.9544), and ART-enrolled (7.3 vs 5.8, p = 0.4672). When comparing DHT versus bPITC+tPITC, there was a significant increase in the mean monthly number of children/adolescents: tested for HIV (223.0 to 542.2, p<0.0001), testing HIV-positive (10.5 vs 20.3, p = 0.0256), and ART-enrolled (7.3 vs 12.2, p = 0.0388). Conclusions These findings suggest that concurrent implementation of bPITC+tPITC was more effective compared to DHT in terms of HIV testing uptake, case detection and ART enrolment. However, considering that DHT and bPITC had comparable outcomes with regards to case detection and ART enrolment, bPITC+tPITC may not be efficient. Thus, this finding does not support concurrent bPITC+tPITC implementation as recommended by WHO. Rather, continued DHT+tPITC could effectively and efficiently accelerate HIV case detection and ART coverage among children and adolescents in Cameroon and similar low-prevalence context.
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Affiliation(s)
- Habakkuk A. Yumo
- R4D International Foundation, Yaoundé, Cameroon
- Center for International Health, Ludwig-Maximilians-Universität of Munich, Munich Germany
- * E-mail:
| | - Rogers A. Ajeh
- R4D International Foundation, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Marcus Beissner
- Center for International Health, Ludwig-Maximilians-Universität of Munich, Munich Germany
| | - Jackson N. Ndenkeh
- R4D International Foundation, Yaoundé, Cameroon
- Center for International Health, Ludwig-Maximilians-Universität of Munich, Munich Germany
| | - Isidore Sieleunou
- R4D International Foundation, Yaoundé, Cameroon
- School of Public Health, University of Montreal, Montreal, Canada
| | - Michael R. Jordan
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Nadia A. Sam-Agudu
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, United States of America
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5
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Yumo HA, Kuaban C, Ajeh RA, Nji AM, Nash D, Kathryn A, Beissner M, Loescher T. Active case finding: comparison of the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated-testing and counseling of HIV among children and adolescents in Cameroon. BMC Pediatr 2018; 18:309. [PMID: 30253758 PMCID: PMC6156944 DOI: 10.1186/s12887-018-1276-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background Children and adolescents still lag behind adults in accessing antiretroviral therapy (ART), which is largely due to their limited access to HIV testing services. This study compares the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated testing and counseling (PITC) among children and adolescents in Cameroon. Methods During a 6-month period in three hospitals in Cameroon, we invited HIV-positive parents to have their biological children (6 weeks-19 years) tested for HIV (targeted PITC). During that same period and in the same hospitals, we also systematically offered HIV testing to all children evaluated at the outpatient department (blanket PITC). Children of consenting parents were tested for HIV, and positive cases were enrolled on ART. We compared the acceptability, feasibility and effectiveness of targeted and blanket PITC using Chi-square test at 5% significant level. Results We enrolled 1240 and 2459 eligible parents in the targeted PITC (tPITC) and blanket PITC (bPITC) group, and 99.7% and 98.8% of these parents accepted the offer to have their children tested for HIV, respectively. Out of the 1990 and 2729 children enrolled in the tPITC and bPITC group, 56.7% and 90.3% were tested for HIV (p < 0.0001), respectively. The HIV positivity rate was 3.5% (CI:2.4–4.5) and 1.6% (CI:1.1–2.1) in the tPITC and bPITC (p = 0.0008), respectively. This finding suggests that the case detection was two times higher in tPITC compared to bPITC, or alternatively, 29 and 63 children have to be tested to identify one HIV case with the implementation of tPITC and bPITC, respectively. The majority (84.8%) of HIV-positive children in the tPITC group were diagnosed earlier at WHO stage 1, and cases were mostly diagnosed at WHO stage 3 (39.1%) (p < 0.0001) in the bPITC group. Among the children who tested HIV-positive, 85.0% and 52.5% from the tPITC and bPITC group respectively, were enrolled on ART (p = 0.0018). Conclusions The tPITC and bPITC strategies demonstrated notable high HIV testing acceptance. tPITC was superior to bPITC in terms of case detection, case detection earliness and linkage to care. These findings indicate that tPITC is effective in case detection and linkage of children and adolescents to ART. Trial registration Trial registration Number: NCT03024762. Name of Registry: ClinicalTrial.gov. Date registration: January 19, 2017 (‘retrospectively registered’). Date of enrolment first patient: 15/07/2015. Electronic supplementary material The online version of this article (10.1186/s12887-018-1276-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Habakkuk Azinyui Yumo
- R4D International Foundation, Yaounde, Cameroon. .,Center for International Health (CIH), Ludwig-Maximilians-Universität, München, Germany.
| | | | | | - Akindeh Mbuh Nji
- R4D International Foundation, Yaounde, Cameroon.,University of Yaounde I, Yaounde, Cameroon
| | - Denis Nash
- CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Anastos Kathryn
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, USA.,Montefiore Medical Center, New York, USA
| | - Marcus Beissner
- Center for International Health (CIH), Ludwig-Maximilians-Universität, München, Germany
| | - Thomas Loescher
- Center for International Health (CIH), Ludwig-Maximilians-Universität, München, Germany
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Penda CI, Moukoko CEE, Koum DK, Fokam J, Meyong CAZ, Talla S, Ndombo PK. Feasibility and utility of active case finding of HIV-infected children and adolescents by provider-initiated testing and counselling: evidence from the Laquintinie hospital in Douala, Cameroon. BMC Pediatr 2018; 18:259. [PMID: 30075712 PMCID: PMC6090739 DOI: 10.1186/s12887-018-1235-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal HIV testing and treatment of infected children remain challenging in resource-limited settings (RLS), leading to undiagnosed children/adolescents and limited access to pediatric antiretroviral therapy (ART). Our objective was to evaluate the feasibility of active cases finding of HIV-infected children/adolescents by provider-initiated testing and counseling in a health facility. METHODS A cross-sectional prospective study was conducted from January through April 2016 at 6 entry-points (inpatient, outpatient, neonatology, immunization/family planning, tuberculosis, day-care units) at the Laquintinie Hospital of Douala (LHD), Cameroon. At each entry-point, following counseling with consenting parents, children/adolescents (0-19 years old) with unknown HIV status were tested using the Rapid Diagnostic Test (RDT) (Determine®) and confirmed with a second RDT (Oraquick®) according to national guidelines. For children less than 18 months, PCR was performed to confirm every positive RDT. Community health workers linked infected participants by accompanying them from the entry-point to the treatment centre for an immediate ART initiation following the « test and treat » strategy. Statistical analysis was performed, with p < 0.05 considered significant. RESULTS Out of 3439 children seen at entry-points, 2107 had an unknown HIV status (61.3%) and HIV testing acceptance rate was 99.9% (2104). Their mean age was 2.1 (Sd = 2.96) years, with a sex ratio boy/girl of 6/5. HIV prevalence was 2.1% (44), without a significant difference between boys and girls (p = 0.081). High rates of HIV-infection were found among siblings/descendants (22.2%), TB treatment unit attendees (11.4%) and hospitalized children/adolescents (5.6%); p < 0.001. Up to 95.4% (42/44) of those infected children/adolescents were initiated on ART. Overall, 487 (23.2%) deaths were registered (122 per month) and among them, 7 (15.9%) were HIV-positive; mainly due to tuberculosis and malnutrition. CONCLUSION The consistent rate of unknown HIV status among children/adolescents attending health facilities, the high acceptability rates of HIV testing and linkage to ART, underscore the feasibility and utility of an active case finding model, using multiple entry-points at the health facility, in achieving the 90-90-90 targets for paediatric HIV/AIDS in RLS.
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Affiliation(s)
- Calixte Ida Penda
- Clinical sciences department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, PO Box 2071, Douala, Cameroon. .,HIV Care and Treatment Centre, Laquintinie Hospital of Douala, Douala, Cameroon.
| | | | - Daniele Kedy Koum
- Clinical sciences department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, PO Box 2071, Douala, Cameroon
| | - Joseph Fokam
- Virology Laboratory, Chantal Biya International Reference Centre for research on HIV/AIDS prevention and management, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Sandrine Talla
- Technical office, Elizabeth Glaser Pediatric AIDS Foundation, LDH, Douala, Cameroon
| | - Paul Koki Ndombo
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Mother-Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon
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Cohn J, Whitehouse K, Tuttle J, Lueck K, Tran T. Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis. Lancet HIV 2016; 3:e473-81. [PMID: 27658876 DOI: 10.1016/s2352-3018(16)30050-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many HIV-positive children in low-income and middle-income countries remain undiagnosed. Although HIV testing in children at health facilities is recommended by WHO, it is not well implemented. This systematic review and meta-analysis examines the case-finding benefit of HIV screening in children aged 0-5 years in low-income and middle-income countries. METHODS We did this systematic review and meta-analysis in accordance with an a-priori protocol. We searched PubMed, MEDLINE, WHO Global Index Medicus, Web of Science, Médecins Sans Frontières, Cochrane, Embase, CABS Abstracts, and LILACS databases for articles published between Jan 1, 2004, and April 30, 2016, that reported the quantitative prevalence of HIV detected through screening in four key contexts (paediatric inpatient settings, paediatric outpatient settings, nutrition centres, and expanded programme on immunisation centres) in paediatric populations in low-income and middle-income countries. Articles were identified and data were extracted in duplicate. The primary outcome was HIV prevalence, for which we used a DerSimonian-Laird random-effects meta-analysis to pool prevalence data and 95% CIs. We did stratified analyses according to geographical context and testing strategy. This study is registered with PROSPERO, number CRD42014014372. FINDINGS Our search found 2996 studies, of which 26 met the inclusion criteria. Paediatric HIV prevalence across all settings was 15·6% (95% CI 11·8-19·5). HIV prevalence by setting was highest in paediatric inpatient settings (21·1%, 95% CI 14·9-27·3), followed by nutrition centres (13·1%, 95% CI 3·4-22·7), expanded programme on immunisation centres (3·3%, 95% CI 0-6·9), and paediatric outpatient settings (2·7%, 95% CI 0·3-5·2). Universal testing and testing triggered by symptoms had similar diagnostic yield in the inpatient setting (21·3%, 95% CI 11·6-31·0 in triggered testing vs 20·9%, 95% CI 13·5-28·3 in universal testing). INTERPRETATION HIV testing in paediatric populations in low-income and middle-income countries outside the context of prevention of mother-to-child transmission programmes provides an important opportunity to identify HIV-positive children. For countries wishing to prioritise interventions, the highest diagnostic yields were obtained from inpatient wards and nutrition centres. Universal testing might be the preferred approach since it did not have a substantially lower diagnostic yield than triggered testing FUNDING None.
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Affiliation(s)
- Jennifer Cohn
- Médecins Sans Frontières, Geneva, Switzerland; Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | | | | | | | - Trang Tran
- Médecins Sans Frontières, Geneva, Switzerland
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