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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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2
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Secor AM, Célestin K, Jasmin M, Honoré JG, Wagner AD, Beima-Sofie K, Pintye J, Puttkammer N. Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy Among Adults and Children Living With HIV in Haiti: Retrospective Longitudinal Study. JMIR Pediatr Parent 2024; 7:e51574. [PMID: 38488632 PMCID: PMC10986334 DOI: 10.2196/51574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63% of children living with HIV know their HIV status (compared to 85% overall), 63% are on treatment (compared to 85% overall), and 48% are virally suppressed (compared to 73% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. Objective We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). Methods We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSanté, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Results Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33% vs n=7477, 23.4% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95% CI 1.26-2.01; P<.001), 1.74 (95% CI 1.02-2.97; P=.04), and 2.25 (95% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. Conclusions These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients.
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Affiliation(s)
- Andrew M Secor
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kemar Célestin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Margareth Jasmin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, Seattle, WA, United States
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3
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Stanic T, McCann N, Penazzato M, Flanagan C, Essajee S, Freedberg KA, Doherty M, Putta N, Myer L, Siberry GK, Collins IJ, Vojnov L, Abrams E, Soeteman DI, Ciaranello AL. Cost-effectiveness of Routine Provider-Initiated Testing and Counseling for Children With Undiagnosed HIV in South Africa. Open Forum Infect Dis 2022; 9:ofab603. [PMID: 35028333 PMCID: PMC8753042 DOI: 10.1093/ofid/ofab603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We compared the cost-effectiveness of pediatric provider-initiated HIV testing and counseling (PITC) vs no PITC in a range of clinical care settings in South Africa. METHODS We used the Cost-Effectiveness of Preventing AIDS Complications Pediatric model to simulate a cohort of children, aged 2-10 years, presenting for care in 4 settings (outpatient, malnutrition, inpatient, tuberculosis clinic) with varying prevalence of undiagnosed HIV (1.0%, 15.0%, 17.5%, 50.0%, respectively). We compared "PITC" (routine testing offered to all patients; 97% acceptance and 71% linkage to care after HIV diagnosis) with no PITC. Model outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs) from the health care system perspective and the proportion of children with HIV (CWH) diagnosed, on antiretroviral therapy (ART), and virally suppressed. We assumed a threshold of $3200/year of life saved (YLS) to determine cost-effectiveness. Sensitivity analyses varied the age distribution of children seeking care and costs for PITC, HIV care, and ART. RESULTS PITC improved the proportion of CWH diagnosed (45.2% to 83.2%), on ART (40.8% to 80.4%), and virally suppressed (32.6% to 63.7%) at 1 year in all settings. PITC increased life expectancy by 0.1-0.7 years for children seeking care (including those with and without HIV). In all settings, the ICER of PITC vs no PITC was very similar, ranging from $710 to $1240/YLS. PITC remained cost-effective unless undiagnosed HIV prevalence was <0.2%. CONCLUSIONS Routine testing improves HIV clinical outcomes and is cost-effective in South Africa if the prevalence of undiagnosed HIV among children exceeds 0.2%. These findings support current recommendations for PITC in outpatient, inpatient, tuberculosis, and malnutrition clinical settings.
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Affiliation(s)
- Tijana Stanic
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicole McCann
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martina Penazzato
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Clare Flanagan
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meg Doherty
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Landon Myer
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - George K Siberry
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Intira Jeannie Collins
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Lara Vojnov
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Elaine Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA.,Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Djøra I Soeteman
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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4
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Nuoh RD, Nyarko KM, Noora CL, Addo-Lartey A, Nortey P, Nuolabong C, Lartey M, Kenu E. Barriers to early infant diagnosis of HIV in the Wa Municipality and Lawra District of Upper West Region, Ghana. Ghana Med J 2021; 54:83-90. [PMID: 33536673 PMCID: PMC7837354 DOI: 10.4314/gmj.v54i2s.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective We identified socio-demographic, health system and psycho-social barriers to Early Infant Diagnosis (EID) of HIV in the Upper West Region of Ghana. Design An unmatched case control study of 96 cases and 96 controls was conducted in the ART centers in Lawra district and Wa Municipality between December 2014 and April 2015. Setting A public health facility Participants We defined a case as an HIV positive mother with an exposed infant who received EID service between January 2011 and December 2014. A control was defined as HIV Positive Mother with an exposed infant who did not receive EID services between January 2011 and December 2014. Main outcome EID by dry blood spot Deoxyribonucleic acid Polymerase chain reaction. Results A total of 192 mother-infant pairs were assessed. The mean age of infants at testing for cases was 17.3±14.9 weeks. Mother-to-child-transmission-rate was 2.3%. Factors associated with EID testing included: mother being formally employed (cOR=2.0: 95%CI:1.1–3.8), maternal formal education (cOR=2.0, 95%CI: 1.1–3.6) and maternal independent source of income (cOR 2.2, 95%CI 1.2–4.1). After adjusting for confounders, maternal independent income source was associated with EID testing (aOR 2.2, 95%CI 1.2–4.1). Median turn-around time of EID result was 11 weeks (IQR 4–27 weeks). Conclusion Women need to be empowered to gain an independent source of income. This can help maximize the benefits of e-MTCT and increase EID in the Upper West Region of Ghana. Funding This work was funded by the authors
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Affiliation(s)
- Robert D Nuoh
- Ghana Field Epidemiology and Laboratory Training Program, Department of Epidemiology, School of Public Health, College of Health Sciences, University of Ghana Legon, Accra, Ghana
| | - Kofi M Nyarko
- Namibia Field Epidemiology and Laboratory Training Program, University of Namibia, Windhoek, Namibia
| | - Charles L Noora
- Ghana Field Epidemiology and Laboratory Training Program, Department of Epidemiology, School of Public Health, College of Health Sciences, University of Ghana Legon, Accra, Ghana
| | - Adolphina Addo-Lartey
- Ghana Field Epidemiology and Laboratory Training Program, Department of Epidemiology, School of Public Health, College of Health Sciences, University of Ghana Legon, Accra, Ghana
| | - Priscillia Nortey
- Ghana Field Epidemiology and Laboratory Training Program, Department of Epidemiology, School of Public Health, College of Health Sciences, University of Ghana Legon, Accra, Ghana
| | - Culbert Nuolabong
- Ghana Field Epidemiology and Laboratory Training Program, Department of Epidemiology, School of Public Health, College of Health Sciences, University of Ghana Legon, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Program, Department of Epidemiology, School of Public Health, College of Health Sciences, University of Ghana Legon, Accra, Ghana.,Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana
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5
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Marichannegowda MH, Mengual M, Kumar A, Giorgi EE, Tu JJ, Martinez DR, Romero-Severson EO, Li X, Feng L, Permar SR, Gao F. Different evolutionary pathways of HIV-1 between fetus and mother perinatal transmission pairs indicate unique immune selection in fetuses. Cell Rep Med 2021; 2:100315. [PMID: 34337555 PMCID: PMC8324465 DOI: 10.1016/j.xcrm.2021.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 11/04/2022]
Abstract
Study of evolution and selection pressure on HIV-1 in fetuses will lead to a better understanding of the role of immune responses in shaping virus evolution and vertical transmission. Detailed genetic analyses of HIV-1 env gene from 12 in utero transmission pairs show that most infections (67%) occur within 2 months of childbirth. In addition, the env sequences from long-term-infected fetuses are highly divergent and form separate phylogenetic lineages from their cognate maternal viruses. Host-selection sites unique to neonate viruses are identified in regions frequently targeted by neutralizing antibodies and T cell immune responses. Identification of unique selection sites in the env gene of fetal viruses indicates that the immune system in fetuses is capable of exerting selection pressure on viral evolution. Studying selection and evolution of HIV-1 or other viruses in fetuses can be an alternative approach to investigate adaptive immunity in fetuses.
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Affiliation(s)
| | - Michael Mengual
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Amit Kumar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - Elena E. Giorgi
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM 87544, USA
| | - Joshua J. Tu
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - David R. Martinez
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Xiaojun Li
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Liping Feng
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA
| | - Sallie R. Permar
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC 27710, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
| | - Feng Gao
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
- School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
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6
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Nyasulu JCY, Maposa I, Sikhakhane BP, Pandya H. Access to HIV services and viral load suppression among children during the 90-90-90 strategy implementation in South Africa: A time series analysis. South Afr J HIV Med 2021; 22:1187. [PMID: 33824733 PMCID: PMC8008010 DOI: 10.4102/sajhivmed.v22i1.1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background During the era of the Millennium Development Goals (MDG), children were shown to have less access to human immunodeficiency virus (HIV) services than their adult counterparts; hence the call to prioritise children in the implementation of the Sustainable Development Goals (SDGs). However, South African (SA) national data in 2019 indicated that almost 3 years into the implementation of the 90-90-90 strategy, only 59% of children living with HIV had been tested for HIV compared to 90% of adults. Objectives To evaluate the access of children to HIV services and record the viral load (VL) suppression rates during the implementation of the 90-90-90 strategy in the City of Johannesburg (COJ), South Africa. Methods This study applied a quasi-experimental interrupted time-series (ITS) design using the monthly District Health Information System (DHIS) and National Health Laboratory Services (NHLS) databases spanning the period from 2015 to 2020, that is, before and after the implementation and roll-out of the 90-90-90 strategy. Data were extracted from these databases into MS Excel 2010 spreadsheets and analysed with Stata 15 software from Stata Corp using a two-tailed t-test at a 5% level of significance. Results Overall, a significant increase was observed in the number of individuals tested for HIV, n = 757, p = 0.0086, and retained in care n = 2523, p = 0.001 over the whole period of analysis beginning in April 2015. Adult HIV testing, antiretroviral treatment (ART) initiation and retention in care had been decreasing in absolute numbers over a 10-month period before the intervention. An increase in these three data elements was observed following the implementation of the 90-90-90 program. On the other hand, children aged 0–15 years had demonstrated a significant increase in absolute numbers tested for HIV, n = 171, p = 0.001, but an insignificant increase in number of ART initiations, n = 14.33, p = 0.252, before implementation but a decrease after this. The overall VL suppression rates for children were lower than those of adults. Conclusion Although the COJ has recorded progress in adult HIV testing, ART initiation and retention, children living with HIV aged 0–15 years continue to experience less access to HIV services and lower VL suppression than youths and adults of ≥ 15 years. Therefore, to ensure that the 90-90-90 targets are achieved across different age groups, children must be prioritised so that they can equally access these services with adults.
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Affiliation(s)
- Juliet C Y Nyasulu
- Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Systems Strengthening, AFRIQUIP, Johannesburg, South Africa
| | - Innocent Maposa
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for HIV and STI's, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Bernard P Sikhakhane
- JHB Health District: Monitoring and Evaluation, Gauteng Provincial Department of Health, Johannesburg, South Africa
| | - Himani Pandya
- Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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7
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Caregiver experience and perceived acceptability of a novel near point-of-care early infant HIV diagnostic test among caregivers enrolled in the PMTCT program, Myanmar: A qualitative study. PLoS One 2020; 15:e0241245. [PMID: 33125390 PMCID: PMC7598472 DOI: 10.1371/journal.pone.0241245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4-6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low testing rates and delays in result communication and treatment initiation. Decentralized point-of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care. AIM This paper aims to explore experiences of caregivers of HIV-exposed infants enrolled in the PMTCT program in Myanmar and the perceived acceptability of point-of-care EID testing compared to conventional centralised laboratory-based testing. METHODS This is a sub-study of the cluster randomised controlled stepped-wedge trial (Trial registration number: ACTRN12616000734460) that assessed the impact of near POC EID testing using Xpert HIV-1 Qual assay in four public hospitals in Myanmar. Caregivers of infants who were enrolled in the intervention phase of the main study, had been tested with both Xpert and standard of care tests and had received the results were eligible for this qualitative study. Semi-structured interviews were conducted with 23 caregivers. Interviews were audio recorded, transcribed verbatim and translated into English. Thematic data analysis was undertaken using NVivo 12 Software (QSR International). RESULTS The majority of caregivers were satisfied with the quality of care provided by PMTCT services. However, they encountered social and financial access barriers to attend the PMTCT clinic regularly. Mothers had concerns about community stigma from the disclosure of their HIV status and the potential consequences for their infants. While medical care at the PMTCT clinics was free, caregivers sometimes experienced financial difficulties associated with out-of-pocket expenses for childbirth and transportation. Some caregivers had to choose not to attend work (impacting their income) or the adult antiretroviral clinic in order to attend the paediatric PMTCT clinic appointment. The acceptability of the Xpert testing process was high among the caregiver participants and more than half received the Xpert result on the same day as testing. Short turnaround time of the near POC EID testing enabled the caregivers to find out their infants' HIV status quicker, thereby shortening the stressful waiting time for results. CONCLUSION Our study identified important access challenges facing caregivers of HIV exposed infants and high acceptability of near POC EID testing. Improving the retention rate in the PMTCT and EID programs necessitates careful attention of program managers and policy makers to these challenges, and POC EID represents a potential solution.
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8
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Sindelar K, Maponga C, Lekoala F, Mandara E, Mohoanyane M, Sanders J, Joseph J. Beyond the facility: An evaluation of seven community-based pediatric HIV testing strategies and linkage to care outcomes in a high prevalence, resource-limited setting. PLoS One 2020; 15:e0236985. [PMID: 32877441 PMCID: PMC7467225 DOI: 10.1371/journal.pone.0236985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 07/18/2020] [Indexed: 11/18/2022] Open
Abstract
Diverse challenges in expanding pediatric HIV testing and treatment coverage persist, making the investigation and adoption of innovative strategies urgent. Evidence is mounting for the effectiveness of community-based testing in bringing such lifesaving services to those in need, particularly in resource-limited settings. The Mobilizing HIV Identification and Treatment project piloted seven community-based testing strategies to assess their effectiveness in reaching HIV-positive children and linking them to care in two districts of Lesotho from October 2015 to March 2018. Children testing HIV-positive were enrolled into the project's mHealth system where they received e-vouchers for transportation assistance to the facility for treatment initiation and were followed-up for a minimum of three months. An average of 7,351 HIV tests were conducted per month across all strategies for all age groups, with 46% of these tests on children 0-14 years. An average of 141.65 individuals tested positive each month; 9% were children. Among the children tested 55% were over 5 years. The yield in children was low (0.38%), however facility-based yields were only slightly higher (0.72%). Seventy-five percent of children were first-time testers and 86% of those testing HIV-positive were first-time testers. Seventy-one percent of enrolled children linked to care, all but one initiated treatment, and 82% were retained in care at three months. As facility-based testing remains the core of HIV programs, this evaluation demonstrates the effectiveness of community-based strategies in finding previously untested children and those over 5 years who have limited interactions with the conventional health system. Utilizing active follow-up mechanisms, linkage rates were high suggesting accessing treatment in a facility after community testing is not a barrier. Overall, these community-based testing strategies contributed markedly to the HIV testing landscape in which they were implemented, demonstrating their potential to help close the gap of unidentified HIV-positive children and achieve universal testing coverage.
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Affiliation(s)
- Kathleen Sindelar
- Clinton Health Access Initiative, Maseru, Lesotho
- * E-mail: (KS); (JJ)
| | | | | | | | | | - Jill Sanders
- Baylor College of Medicine Children’s Foundation – Lesotho, Maseru, Lesotho
| | - Jessica Joseph
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
- * E-mail: (KS); (JJ)
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Okoko N, Kulzer JL, Ohe K, Mburu M, Muttai H, Abuogi LL, Bukusi EA, Cohen CR, Penner J. They are likely to be there: using a family-centered index testing approach to identify children living with HIV in Kenya. Int J STD AIDS 2020; 31:1028-1033. [PMID: 32693739 DOI: 10.1177/0956462420926344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Kenya, only half of children with a parent living with HIV have been tested for HIV. The effectiveness of family-centered index testing to identify children (0-14 years) living with HIV was examined. A retrospective record review was conducted among adult index patients newly enrolled in HIV care between May and July 2015; family testing, results, and linkage to treatment outcomes were followed through May 2016 at 60 high-volume clinics in Kenya. Chi square test compared yield (percentage of HIV tests positive) among children tested through family-centered index testing, outpatient and inpatient testing. Review of 1937 index client charts led to 3005 eligible children identified for testing. Of 2848 (94.8%) children tested through family-centered index testing, 127 (4.5%) had HIV diagnosed, 100 (78.7%) were linked to care, and 85 of those eligible (91.4%) initiated antiretroviral therapy (ART).Family testing resulted in higher yield compared to inpatient (1.8%, p < 0.001) or outpatient testing (1.6%, p < 0.001). The absolute number of children living with HIV identified was highest with outpatient testing. The relative contribution of testing approach to total children identified with HIV was outpatient testing (69%), family testing (26%), and inpatient testing (5%). The family testing approach demonstrated promise in achieving the first two "90s" (identification and ART initiation) of the 90-90-90 targets for children, with additional effort required to improve linkage from testing to treatment.
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Affiliation(s)
- Nicollate Okoko
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jayne L Kulzer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kristen Ohe
- School of Medicine, University of Colorado, Denver, CO, USA
| | - Margaret Mburu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Hellen Muttai
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Lisa L Abuogi
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Brief Report: Diagnostic Accuracy of Oral Mucosal Transudate Tests Compared with Blood-Based Rapid Tests for HIV Among Children Aged 18 Months to 18 Years in Kenya and Zimbabwe. J Acquir Immune Defic Syndr 2020; 82:368-372. [PMID: 31425318 PMCID: PMC6830960 DOI: 10.1097/qai.0000000000002146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gaps persist in HIV testing for children who were not tested in prevention of mother-to-child HIV transmission programs. Oral mucosal transudate (OMT) rapid HIV tests have been shown to be highly sensitive in adults, but their performance has not been established in children.
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11
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Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness. Sci Rep 2019; 9:12621. [PMID: 31477764 PMCID: PMC6718403 DOI: 10.1038/s41598-019-49109-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022] Open
Abstract
Although many African countries have achieved high levels of HIV diagnosis, funding constraints have necessitated greater focus on more efficient testing approaches. We compared the impact and cost-effectiveness of several potential new testing strategies in South Africa, and assessed the prospects of achieving the UNAIDS target of 95% of HIV-positive adults diagnosed by 2030. We developed a mathematical model to evaluate the potential impact of home-based testing, mobile testing, assisted partner notification, testing in schools and workplaces, and testing of female sex workers (FSWs), men who have sex with men (MSM), family planning clinic attenders and partners of pregnant women. In the absence of new testing strategies, the diagnosed fraction is expected to increase from 90.6% in 2020 to 93.8% by 2030. Home-based testing combined with self-testing would have the greatest impact, increasing the fraction diagnosed to 96.5% by 2030, and would be highly cost-effective compared to currently funded HIV interventions, with a cost per life year saved (LYS) of $394. Testing in FSWs and assisted partner notification would be cost-saving; the cost per LYS would also be low in the case of testing MSM ($20/LYS) and self-testing by partners of pregnant women ($130/LYS).
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12
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Dziva Chikwari C, Simms V, Dringus S, Kranzer K, Bandason T, Vasantharoopan A, Chikodzore R, Sibanda E, Mutseta M, Webb K, Engelsmann B, Ncube G, Mujuru H, Apollo T, Weiss HA, Ferrand R. Evaluating the effectiveness and cost-effectiveness of health facility-based and community-based index-linked HIV testing strategies for children: protocol for the B-GAP study in Zimbabwe. BMJ Open 2019; 9:e029428. [PMID: 31289091 PMCID: PMC6615786 DOI: 10.1136/bmjopen-2019-029428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/16/2019] [Accepted: 06/21/2019] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The number of new paediatric infections per year has declined in sub-Saharan Africa due to prevention-of-mother-to-child HIV transmission programmes; many children and adolescents living with HIV remain undiagnosed. In this protocol paper, we describe the methodology for evaluating an index-linked HIV testing approach for children aged 2-18 years in health facility and community settings in Zimbabwe. METHODS AND ANALYSIS Individuals attending for HIV care at selected primary healthcare clinics (PHCs) will be asked if they have any children aged 2-18 years in their households who have not been tested for HIV. Three options for HIV testing for these children will be offered: testing at the PHC; home-based testing performed by community workers; or an oral mucosal HIV test given to the caregiver to test the children at home. All eligible children will be followed-up to ascertain whether HIV testing occurred. For those who did not test, reasons will be determined, and for those who tested, the HIV test result will be recorded. The primary outcome will be uptake of HIV testing. The secondary outcomes will be preferred HIV testing method, HIV yield, prevalence and proportion of those testing positive linking to care and having an undetectable viral load at 12 months. HIV test results will be stratified by sex and age group, and factors associated with uptake of HIV testing and choice of HIV testing method will be investigated. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the Medical Research Council of Zimbabwe, the London School of Hygiene and Tropical Medicine and the Institutional Review Board of the Biomedical Research and Training Institute. Study results will be presented at national policy meetings and national and international research conferences. Results will also be published in international peer-reviewed scientific journals and disseminated to study communities at the end of study.
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Affiliation(s)
- Chido Dziva Chikwari
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Katharina Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe
- London School of Hygiene and Tropical Medicine, London, UK
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Rudo Chikodzore
- Matebeleland South, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - Edwin Sibanda
- City Health Department, Bulawayo City Council, Bulawayo, Zimbabwe
| | - Miriam Mutseta
- Population Services International Zimbabwe, Harare, Zimbabwe
| | - Karen Webb
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Barbara Engelsmann
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Gertrude Ncube
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Hilda Mujuru
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tsitsi Apollo
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Chen H, Liu K, Li Z, Wang P. Point of care testing for infectious diseases. Clin Chim Acta 2019; 493:138-147. [PMID: 30853460 PMCID: PMC6462423 DOI: 10.1016/j.cca.2019.03.008] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 01/06/2023]
Abstract
Infectious diseases are caused by pathogenic microorganisms and can be transmitted between individuals and populations thus threatening the general public health and potentially the economy. Efficient diagnostic tools are needed to provide accurate and timely guidance for case identification, transmission disruption and appropriate treatment administration. Point of care (POC) tests provide actionable results near the patient and thereby serve as a personal "radar". In this review, we review clinical needs for POC testing for several major pathogens, including malaria parasites, human immunodeficiency virus (HIV), human papillomavirus (HPV), dengue, Ebola and Zika viruses and Mycobacterium tuberculosis (TB). We compare different molecular approaches, including pathogen nucleic acid and protein, circulating microRNA and antibodies, used in the POC tests. Finally, we review recent advances in novel POC technologies focusing on microfluidic and plasmonic-based approaches.
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Affiliation(s)
- Hui Chen
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Kengku Liu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Zhao Li
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ping Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
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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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15
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Ochigbo SO, Torty C, Anah M. Prevalence of HIV infection among siblings of HIV positive children in Calabar, Nigeria. Pan Afr Med J 2019; 32:179. [PMID: 31312293 PMCID: PMC6620075 DOI: 10.11604/pamj.2019.32.179.16837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/10/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Early diagnosis and treatment of paediatric HIV is key as mortality of untreated patients is very high in the first two years of life, and reaches 80% by four years. Case finding efforts for children especially outside Prevention of mother-to-child transmission (PMTCT) is inadequate. Targeting siblings of index HIV-exposed and infected children is an important way of improving identification and enrolment into care thereby reducing paediatric mortality. The study therefore aimed to determine the prevalence of HIV infection among siblings of HIV positive children in care in Calabar. METHODS This descriptive cross-sectional study was conducted among children aged six weeks to 15 years who are siblings of HIV positive children receiving care. Parental consent and child assent were obtained, the children were tested for HIV at their homes irrespective of their prior test results. Ethical clearance certificates were obtained from the health institutions. RESULTS Siblings of 401 index patients were tested for HIV, four were positive giving a prevalence rate of 1%. Three hundred and sixty-seven 367(91.5%) had been tested previously while 34(8.5%) never had HIV test. Among the siblings who were HIV positive, 1(0.3%) was a male while 3(0.7%) were females. There were more HIV positive siblings in the 11-15 years age group. CONCLUSION All the four HIV positive siblings were from the lower socioeconomic class (p=0.022). The routine screening of siblings of HIV positive children should be sustained with focus on adolescents from the lower socioeconomic class. This will improve early identification and enrolment into care thereby reducing paediatric mortality.
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Affiliation(s)
| | - Chimaeze Torty
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Maxwell Anah
- Faculty of Medicine, Department of Paediatrics, University of Calabar, Calabar, Nigeria
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Medley AM, Hrapcak S, Golin RA, Dziuban EJ, Watts H, Siberry GK, Rivadeneira ED, Behel S. Strategies for Identifying and Linking HIV-Infected Infants, Children, and Adolescents to HIV Treatment Services in Resource Limited Settings. J Acquir Immune Defic Syndr 2018; 78 Suppl 2:S98-S106. [PMID: 29994831 PMCID: PMC10961643 DOI: 10.1097/qai.0000000000001732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Many children living with HIV in resource-limited settings remain undiagnosed and at risk for HIV-related mortality and morbidity. This article describes 5 key strategies for strengthening HIV case finding and linkage to treatment for infants, children, and adolescents. These strategies result from lessons learned during the Accelerating Children's HIV/AIDS Treatment Initiative, a public-private partnership between the President's Emergency Plan for AIDS Relief (PEPFAR) and the Children's Investment Fund Foundation (CIFF). The 5 strategies include (1) implementing a targeted mix of HIV case finding approaches (eg, provider-initiated testing and counseling within health facilities, optimization of early infant diagnosis, index family testing, and integration of HIV testing within key population and orphan and vulnerable children programs); (2) addressing the unique needs of adolescents; (3) collecting and using data for program improvement; (4) fostering a supportive political and community environment; and (5) investing in health system-strengthening activities. Continued advocacy and global investments are required to eliminate AIDS-related deaths among children and adolescents.
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Affiliation(s)
- Amy M. Medley
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Susan Hrapcak
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Rachel A. Golin
- United States Agency for International Development (USAID), Office of HIV/AIDS, Washington, DC
| | - Eric J. Dziuban
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Heather Watts
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - George K. Siberry
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - Emilia D. Rivadeneira
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Stephanie Behel
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
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Acceptability and Effectiveness of Assisted Human Immunodeficiency Virus Partner Services in Mozambique: Results From a Pilot Program in a Public, Urban Clinic. Sex Transm Dis 2017; 43:690-695. [PMID: 27893598 DOI: 10.1097/olq.0000000000000529] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Assisted partner services (APS) involves offering persons with human immunodeficiency virus (HIV) assistance notifying and testing their sex partners. Assisted partner services is rarely available in sub-Saharan Africa. We instituted a pilot APS program in Maputo, Mozambique. METHODS Between June and September 2014, community health workers (CHWs) offered APS to persons with newly diagnosed HIV (index patients [IPs]). Community health workers interviewed IPs at baseline, 4 and 8 weeks. At baseline, CHWs counseled IPs to notify partners and encourage their HIV testing, but did not notify partners directly. At 4 weeks, CHWs notified partners directly. We compared 4- and 8-week outcomes to estimate the impact of APS on partner notification, HIV testing and HIV case finding. RESULTS Community health workers offered 223 IPs APS, of whom 220 (99%) accepted; CHWs collected complete follow-up data on 206 persons; 79% were women, 74% were married, and 50% named >1 sex partner. Index patients named 262 HIV-negative partners at baseline. At 4 weeks, before APS, IPs had notified 193 partners (74%), but only 82 (31%) had HIV tested; 43 (13%) tested HIV positive. Assisted partner services resulted in the notification of 22 additional partners, testing of 83 partners and 43 new HIV diagnoses. In relative terms, APS increased partner notification, testing, and HIV case finding by 13%, 101%, and 125%. Seventy-two (35%) of 206 IPs were in ongoing HIV serodiscordant partnerships. Only 2.5 IPs needed to receive APS to identify a previously undiagnosed HIV-infected partner or an ongoing HIV serodiscordant partnership. Two (1%) IPs reported APS-related adverse events. CONCLUSIONS Assisted partner services is acceptable to Mozambicans newly diagnosed with HIV, identifies large numbers of serodiscordant partnerships and persons with undiagnosed HIV, and poses a low risk of adverse events.
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High risk of loss to follow-up among South African children on ART during transfer, a retrospective cohort analysis with community tracing. J Int AIDS Soc 2017; 20:21748. [PMID: 28691440 PMCID: PMC5515030 DOI: 10.7448/ias.20.1.21748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Decentralization of HIV care for children has been recommended to improve paediatric outcomes by making antiretroviral treatment (ART) more accessible. We documented outcomes of children transferred after initiating ART at a large tertiary hospital in the Eastern Cape of South Africa. Methods: Electronic medical records for all children 0–15 years initiating ART at Dora Nginza Hospital (DNH) in Port Elizabeth, South Africa January 2004 to September 2015 were examined. Records for children transferred to primary and community clinics were searched at 16 health facilities to identify children with successful (at least one recorded visit) and unsuccessful transfer (no visits). We identified all children lost to follow-up (LTF) after ART initiation: those LTF at DNH (no visit >6 months), children with unsuccessful transfer, and children LTF after successful transfer (no visit >6 months). Community tracing was conducted to locate caregivers of children LTF and electronic laboratory data were searched to measure reengagement in care, including silent transfers. Results: 1,582 children initiated ART at median age of 4 years [interquartile range (IQR): 1–8] and median CD4+ of 278 cells/mm3 [IQR: 119–526]. A total of 901 (57.0%) children were transferred, 644 (71.5%) to study facilities; 433 (67.2%) children had successful transfer and 211 (32.8%) had unsuccessful transfer. In total, 399 children were LTF: 105 (26.3%) from DNH, 211 (52.9%) through unsuccessful transfer and 83 (20.8%) following successful transfer. Community tracing was conducted for 120 (30.1%) of 399 children LTF and 66 (55.0%) caregivers were located and interviewed. Four children had died. Among 62 children still alive, 8 (12.9%) were reported to not be in care or taking ART and 18 (29.0%) were also not taking ART. Overall, 65 (16.3%) of 399 children LTF had a laboratory result within 18 months of their last visit indicating silent transfer and 112 (28.1%) had lab results from 2015 to 2016 indicating current care. Conclusion: We found that only two-thirds of children on ART transferred to primary and community health clinics had successful transfer. These findings suggest that transfer is a particularly vulnerable step in the paediatric HIV care cascade.
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Wagner AD, Njuguna IN, Andere RA, Cranmer LM, Okinyi HM, Benki-Nugent S, Chohan BH, Maleche-Obimbo E, Wamalwa DC, John-Stewart GC. Infant/child rapid serology tests fail to reliably assess HIV exposure among sick hospitalized infants. AIDS 2017; 31:F1-F7. [PMID: 28609404 PMCID: PMC5540651 DOI: 10.1097/qad.0000000000001562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The WHO guidelines for infant and child HIV diagnosis recommend the use of maternal serology to determine child exposure status in ages 0-18 months, but suggest that infant serology can reliably be used to determine exposure for those less than 4 months. There is little evidence about the performance of these recommendations among hospitalized sick infants and children. METHODS Within a clinical trial (NCT02063880) in Kenya, among children 18 months or younger, maternal and child rapid serologic HIV tests were performed in tandem. Dried blood spots were tested using HIV DNA PCR for all children whose mothers were seropositive, irrespective of child serostatus. We characterized the performance of infant/child serology results to detect HIV exposure in three age groups: 0-3, 4-8, and 9-18 months. RESULTS Among 65 maternal serology positive infants age 0-3 months, 48 (74%), 1 (2%) and 16 (25%) had positive, indeterminate and negative infant serology results, respectively. Twelve (25%), 0 and 4 (25%) of those with positive, indeterminate and negative infant serology results, respectively, were HIV-infected by DNA PCR. Among 71 maternal serology positive infants age 4-8 months, 31 (44%), 8 (11%) and 32 (45%) had positive, indeterminate and negative infant serology results, respectively. Fourteen (45%), 2 (25%) and 7 (22%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. Among 67 maternal serology positive infants/children age 9-18 months, 40 (60%), 2 (3%) and 25 (37%) had positive, indeterminate and negative infant serology results, respectively. Thirty-six (90%), 2 (100%) and 2 (8%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. In the 0-3, 4-8 and 9-18 month age groups, use of maternal serology to define HIV exposure identified 33% [95% confidence interval (CI) 10-65%], 44% (95% CI 20-70%) and 5% (95% CI 0.1-18%) more HIV infections, respectively. CONCLUSION Maternal serology should preferentially be used for screening among hospitalized infants of all ages to improve early diagnosis of children with HIV.
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Affiliation(s)
- Anjuli D Wagner
- aDepartment of Global Health, University of Washington, Seattle, Washington, USA bKenyatta National Hospital, Nairobi, Kenya cDepartment of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA dDepartment of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya eDepartment of Medicine, University of Washington, Seattle, Washington, USA fKenya Medical Research Institute, Nairobi, Nairobi, Kenya gDepartment of Epidemiology hDepartment of Pediatrics, University of Washington, Seattle, Washington, USA. *Anjuli D. Wagner and Irene N. Njuguna are co-first authors
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Implementation and Operational Research: Active Referral of Children of HIV-Positive Adults Reveals High Prevalence of Undiagnosed HIV. J Acquir Immune Defic Syndr 2017; 73:e83-e89. [PMID: 27846074 DOI: 10.1097/qai.0000000000001184] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Few routine systems exist to test older, asymptomatic children for HIV. Testing all children in the population has high uptake but is inefficient, whereas testing only symptomatic children increases efficiency but misses opportunities to optimize outcomes. Testing children of HIV-infected adults in care may efficiently identify previously undiagnosed HIV-infected children before symptomatic disease. METHODS HIV-infected parents in HIV care in Nairobi, Kenya were systematically asked about their children's HIV status and testing history. Adults with untested children ≤12 years old were actively referred and offered the choice of pediatric HIV testing at home or clinic. Testing uptake and HIV prevalence were determined, as were bottlenecks in pediatric HIV testing cascade. RESULTS Of 10,426 HIV-infected adults interviewed, 8,287 reported having children, of whom 3,477 (42%) had children of unknown HIV status, and 611 (7%) had children ≤12 years of unknown HIV status. After implementation of active referral, the rate of pediatric HIV testing increased 3.8-fold from 3.5 to 13.6 children tested per month (Relative risk: 3.8, 95% confidence interval: 2.3 to 6.1). Of 611 eligible adults, 279 (48%) accepted referral and were screened, and 74 (14%) adults completed testing of 1 or more children. HIV prevalence among 108 tested children was 7.4% (95% confidence interval: 3.3 to 14.1%) and median age was 8 years (interquartile range: 2-11); 1 child was symptomatic at testing. CONCLUSIONS Referring HIV-infected parents in care to have their children tested revealed many untested children and significantly increased the rate of pediatric testing; prevalence of HIV was high. However, despite increases in pediatric testing, most adults did not complete testing of their children.
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Wondafrash B, Hiko D. Dried Blood Spot Test for HIV Exposed Infants and Children and Their Anti-Retro Viral Treatment Status in Selected Hospitals in Ethiopia. Ethiop J Health Sci 2016; 26:17-24. [PMID: 26949312 PMCID: PMC4762955 DOI: 10.4314/ejhs.v26i1.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infants and children living with HIV receive antiretroviral treatment often late, are exposed to opportunistic infection and quickly develop AIDS. Few hospitals are providing ART service after Dried Blood Spot (DBS)test.The objective of this study is to assess the status of infants and children linked to ART. METHODS Descriptive cross-sectional study was conducted in hospitals. Data of 138 infants and children exposed to HIV were collected from registration books and data bases from 2009 to 2011. Data were analyzed using SPSS version 16. Chi-squared test and p-value were computed. In-depth interviews were conducted with key informants. RESULT Ninety-eight (71%) infants and children exposed to HIV were diagnosed for HIV infection of which 68(69.4%) initiated ART. Twenty four (35.3%) initiated ART one month after HIV screening results. Thirty-three (50.0%) and 23(35.3%) infants and children dropped from and adhered to ART respectively. Eleven (16.2%) of them who initiated ART died within the study period. HIV infection status (p-value=0.003), dropping from ART (p-value=0.002) and death after ART initiation (p-value=0.010) showed significance with mothers' PMTCT service status. CONCLUSION Seven in ten HIV-exposed infants and children were diagnosed with HIV, and almost all of them initiated ART. The overall turnaround time was 10 days. Based up on mothers' PMTCT service status, there was a significant difference among HIV-exposed infants and children in acquiring HIV infection from mothers during pregnancy (p-value=0.003) and dropping from ART (p-value=0.010). There were challenges in sample collection and transportation. Early HIV screening during pregnancy and PMTCT service should be strengthened.
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Affiliation(s)
- Beyene Wondafrash
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Desta Hiko
- Depatement of Epidemiology, Jimma University, Jimma, Ethiopia
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Chamla D, Luo C, Adjorlolo-Johnson G, Vandelaer J, Young M, Costales MO, McClure C. Integration of HIV infant testing into immunization programmes: a systematic review. Paediatr Int Child Health 2016; 35:298-304. [PMID: 26744153 DOI: 10.1080/20469047.2015.1109233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integration of HIV infant testing into immunization sessions is one of the strategies designed to increase coverage of early infant diagnosis. OBJECTIVE To determine the evidence on the outcomes of such integration. METHODS A systematic review of peer-reviewed and grey literature was undertaken from electronic sources such as MEDLINE, Google Scholar, websites of international agencies, past conferences and ministries of health reports published between year 2002 and 2013. Randomized controlled trials, observational and qualitative studies were searched and those meeting selection criteria were selected and relevant information extracted using structured tool. Statistical pooling was not possible owing to the heterogeneity of the study designs and outcome measures. RESULTS Of the nine articles which met the selection criteria, none used a randomized controlled design. Of these, five articles measured mother's acceptability of their infants being tested for HIV during its first pentavalent or DPT vaccination visit, and 89·5-100% accepted. Four articles reported the proportion of mothers who returned for HIV test results, ranging from 56·8% to 86·0%. Increased uptake of HIV testing following integration was confirmed by two articles. Only one study in Tanzania determined the uptake of vaccinations following integration, with urban facilities showing stable or slight increase of monthly vaccine uptake while decreases were observed across the rural sites. In two articles, stigma was perceived by service-providers and mothers as the potential risk following integration, particularly in rural settings. DISCUSSION Despite the limited number of articles, the findings in this systematic review suggest that HIV testing during immunization clinic visits is acceptable and feasible as a possible model for service delivery. However, the impact on vaccination uptake needs further study.
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Expanding coverage of paediatric HIV testing. Lancet HIV 2016; 3:e451-3. [PMID: 27658877 DOI: 10.1016/s2352-3018(16)30064-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/21/2022]
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Tay A, Pavesi A, Yazdi SR, Lim CT, Warkiani ME. Advances in microfluidics in combating infectious diseases. Biotechnol Adv 2016; 34:404-421. [PMID: 26854743 PMCID: PMC7125941 DOI: 10.1016/j.biotechadv.2016.02.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/11/2022]
Abstract
One of the important pursuits in science and engineering research today is to develop low-cost and user-friendly technologies to improve the health of people. Over the past decade, research efforts in microfluidics have been made to develop methods that can facilitate low-cost diagnosis of infectious diseases, especially in resource-poor settings. Here, we provide an overview of the recent advances in microfluidic devices for point-of-care (POC) diagnostics for infectious diseases and emphasis is placed on malaria, sepsis and AIDS/HIV. Other infectious diseases such as SARS, tuberculosis, and dengue are also briefly discussed. These infectious diseases are chosen as they contribute the most to disability-adjusted life-years (DALYs) lost according to the World Health Organization (WHO). The current state of research in this area is evaluated and projection toward future applications and accompanying challenges are also discussed.
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Affiliation(s)
- Andy Tay
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore 117575, Singapore; Department of Bioengineering, University of California Los Angeles, CA 90025, United States
| | - Andrea Pavesi
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore
| | - Saeed Rismani Yazdi
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; Polytechnic University of Milan, Milan 20133, Italy
| | - Chwee Teck Lim
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; Mechanobiology Institute, National University of Singapore, Singapore 117411, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore 117575, Singapore
| | - Majid Ebrahimi Warkiani
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; School of Mechanical and Manufacturing Engineering, Australian Centre for NanoMedicine, University of New South Wales, Sydney, NSW 2052, Australia.
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Ruthven JS. "Making it personal": ideology, the arts, and shifting registers in health promotion. AIDS Care 2016; 28 Suppl 4:72-82. [PMID: 27306743 DOI: 10.1080/09540121.2016.1195485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In South Africa, health promotion related to HIV/AIDS has been characterised as a component of public health prevention. It has heavily utilised global health ideology to construct promotional messages that rely on neoliberal models of individual, responsible health citizenship. However, after nearly 30 years of public health messaging, there have been only minor shifts in the country's HIV prevalence rates; it has become apparent that there is disconnect between policy, programmes, and target audiences. Debates about where this disconnect occurs tend to focus on the role of problems in biomedical knowledge translation or with structural inequalities that lead to health inequity. As debates increase, artists involved in health have emerged to address an additional reason: audience interpellation. In this article, I interrogate relationships between health promotion ideology and processes of interpellation. I suggest that disconnect between the two has roots in the tone of programming, the ways sociality is constructed within health promotion, and the kind of subject which global prevention programmes seek to constitute. Using a case study, I illustrate how public health ideology is made actionable through arts practice. While conventional health promotion programmes address populations in a way that allows individuals to distance themselves, members of South Africa's arts sector have worked to integrate prevention and care in a way that bolsters interpellation through making messages personal. The case study presents one performance but is informed by my broader research with over 20 theatrical groups conducted during 18 months of fieldwork. Analysis of the production reveals that artists act as mediators between population-level public health messages and individuals through the embodied technologies of applied theatre. However, I argue that artists also create space for participants to reimagine configurations of care, responsibility, and intimacy within health practices.
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Affiliation(s)
- Jessica S Ruthven
- a School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Anthropology , Washington University in Saint Louis , Saint Louis , MO , USA
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Van Rooyen HE, Strode AE, Slack CM. HIV testing of children is not simple for health providers and researchers: Legal and policy frameworks guidance in South Africa. S Afr Med J 2016; 106:37-9. [PMID: 27138658 PMCID: PMC5835667 DOI: 10.7196/samj.2016.v106i5.10484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/07/2016] [Indexed: 11/08/2022] Open
Abstract
Antiretroviral treatment coverage for children and adolescents is significantly lower than that for adults. A first step in improving this situation is ensuring increased access to HIV counselling and testing services. Current legal and policy frameworks outline four norms that should inform HIV testing of children in South Africa: limiting HIV testing to defined circumstances, and ensuring that consent is obtained, counselling is provided and confidentiality is maintained. Implementing these norms is not simple. We discuss the challenges and opportunities these norms present for children, their families, health providers and researchers working in this area. Better alignment between evolving public health approaches and the HIV counselling and testing legal/policy frameworks (and the internal coherence of domestic frameworks) would better serve children, their parents and those who work with them.
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Affiliation(s)
- Heidi Eve Van Rooyen
- Human and Social Development Programme, Human Sciences Research Council, Durban, South Africa.
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Njuguna IN, Wagner AD, Cranmer LM, Otieno VO, Onyango JA, Chebet DJ, Okinyi HM, Benki-Nugent S, Maleche-Obimbo E, Slyker JA, John-Stewart GC, Wamalwa DC. Hospitalized Children Reveal Health Systems Gaps in the Mother-Child HIV Care Cascade in Kenya. AIDS Patient Care STDS 2016; 30:119-24. [PMID: 27308805 DOI: 10.1089/apc.2015.0239] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To identify missed opportunities in HIV prevention, diagnosis, and linkage to care, we enrolled 183 hospitalized, HIV-infected, ART-naïve Kenyan children 0-12 years from four hospitals in Nairobi and Kisumu, and reviewed prevention of mother-to-child transmission of HIV (PMTCT), hospitalization, and HIV testing history. Median age was 1.8 years (IQR = 0.8, 4.5). Most mothers received HIV testing during pregnancy (77%). Among mothers tested, 60% and 40% reported HIV-negative and positive results, respectively; 33% of HIV-diagnosed mothers did not receive PMTCT antiretrovirals. First missed opportunities for pediatric diagnosis and linkage were due to failure to test mothers (23.1%), maternal HIV acquisition following initial negative test (45.7%), no early infant diagnosis (EID) or provider-initiated testing (PITC) (12.7%), late breastfeeding transmission (8.7%), failure to collect child HIV test results (1.2%), and no linkage to care following HIV diagnosis (8.7%). Among previously hospitalized children, 38% never received an HIV test. Strengthening initial and repeat maternal HIV testing and PITC are key interventions to prevent, detect, and treat pediatric HIV infections.
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Affiliation(s)
- Irene N. Njuguna
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, Washington
| | - Lisa M. Cranmer
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Vincent O. Otieno
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Judith A. Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Daisy J. Chebet
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Helen M. Okinyi
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | | | | | - Jennifer A. Slyker
- Department of Global Health, University of Washington, Seattle, Washington
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology and Pediatrics, University of Washington, Seattle, Washington
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Thurman TR, Luckett B, Taylor T, Carnay M. Promoting uptake of child HIV testing: an evaluation of the role of a home visiting program for orphans and vulnerable children in South Africa. AIDS Care 2016; 28 Suppl 2:7-13. [PMID: 27391993 PMCID: PMC4991227 DOI: 10.1080/09540121.2016.1176679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
HIV counseling and testing (HCT) is critical for children in generalized epidemic settings, but significant shortfalls in coverage persist, notably among orphans and others at disproportionate risk of infection. This study investigates the impact of a home visiting program in South Africa on orphaned and vulnerable children's uptake of HCT. Using propensity score matching, survey data for children receiving home visits from trained community-based care workers were compared to data from children living in similar households that had not yet received home visits (n = 1324). Home visits by community-based care workers increased the odds of a child being tested by 97% (OR = 1.97, 95% CI = 1.34-2.92). The home visitation program had an especially pronounced effect on orphans, more than doubling their odds of being tested (OR = 2.12, 95% CI = 1.00-4.47) compared to orphans living in similar households that did not receive home visits. Orphan status alone had no effect on HCT independent of program exposure, suggesting that the program was uniquely able to increase testing in this subgroup. Results highlight the potential for increasing HCT access among children at high risk through targeted community-based initiatives.
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Affiliation(s)
- Tonya R. Thurman
- Highly Vulnerable Children Research Center, School of Social Work, Tulane University, New Orleans, LA, USA
| | - Brian Luckett
- Highly Vulnerable Children Research Center, School of Social Work, Tulane University, New Orleans, LA, USA
| | - Tory Taylor
- Highly Vulnerable Children Research Center, School of Social Work, Tulane University, New Orleans, LA, USA
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Melissa Carnay
- Highly Vulnerable Children Research Center, School of Social Work, Tulane University, New Orleans, LA, USA
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Feucht UD, Meyer A, Thomas WN, Forsyth BWC, Kruger M. Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care. AIDS Care 2015; 28:32-42. [PMID: 26273853 DOI: 10.1080/09540121.2015.1066748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
HIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation. Baseline data were reviewed of all children aged <15 years referred over a 1-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one-quarter (24.5%) was of school-going age, 34.5% in the preschool group, 18% between 6 and 12 months old and 23% below 6 months of age (median age = 1.5 years [interquartile range 0.5-4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%). A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (≥89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the second and third pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-to-Health Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART services despite referral. In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not attending paediatric ART services need further exploration.
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Affiliation(s)
- Ute D Feucht
- a Department of Paediatrics , Kalafong Hospital, University of Pretoria , Pretoria , South Africa
| | - Anell Meyer
- a Department of Paediatrics , Kalafong Hospital, University of Pretoria , Pretoria , South Africa
| | - Winifred N Thomas
- a Department of Paediatrics , Kalafong Hospital, University of Pretoria , Pretoria , South Africa
| | - Brian W C Forsyth
- a Department of Paediatrics , Kalafong Hospital, University of Pretoria , Pretoria , South Africa.,b Department of Pediatrics , Yale University , New Haven , CT , USA
| | - Mariana Kruger
- c Department of Paediatrics and Child Health , University of Stellenbosch , Tygerberg , South Africa
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Abstract
BACKGROUND UNAIDS aims for 90% of HIV-positive individuals to be diagnosed by 2020, but few attempts have been made in developing countries to estimate the fraction of the HIV-positive population that has been diagnosed. METHODS To estimate the rate of HIV diagnosis in South Africa, reported numbers of HIV tests performed in the South African public and private health sectors were aggregated, and estimates of HIV prevalence in individuals tested for HIV were combined. The data were integrated into a mathematical model of the South African HIV epidemic, which was additionally calibrated to estimates of the fraction of the population ever tested for HIV, as reported in three national household surveys. RESULTS The fraction of HIV-positive adults who were undiagnosed declined from more than 80% in the early 2000s to 23.7% [95% confidence interval (95% CI) 23.1-24.3] in 2012. The undiagnosed proportion in 2012 was substantially higher in men (31.9%, 95% CI 29.7-34.3) than in women (19.0%, 95% CI 17.9-19.9). Projected probabilities of experiencing disease progression (CD4 cell count <350 cells/μl) without diagnosis are more than 50% for most HIV-positive adults over the age of 40. The fraction of HIV-positive adults who are undiagnosed is projected to decline to 8.9% by 2020 if current targets (10 million tests per annum) are met. CONCLUSION South Africa has made significant progress in expanding access to HIV testing, and at current testing rates, the target of 90% of HIV-positive adults diagnosed by 2020 is likely to be reached. However, uptake is relatively low in men and older adults.
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Wagner A, Slyker J, Langat A, Inwani I, Adhiambo J, Benki-Nugent S, Tapia K, Njuguna I, Wamalwa D, John-Stewart G. High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs. BMC Pediatr 2015; 15:10. [PMID: 25886564 PMCID: PMC4359474 DOI: 10.1186/s12887-015-0325-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/26/2015] [Indexed: 11/17/2022] Open
Abstract
Background Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies. Methods HIV-exposed infants <12 months old were recruited from 9 PMTCT sites in public maternal child health (MCH) clinics or from an inpatient setting in Nairobi, Kenya and tested for HIV using HIV DNA assays. A subset of HIV-infected infants <4.5 months of age was enrolled in a research study and followed for 2 years. HIV prevalence, number needed to test, infant age at testing, and turnaround time for tests were compared between PMTCT programs and hospital sites. Among the enrolled cohort, baseline characteristics, survival, and timing of antiretroviral therapy (ART) initiation were compared between infants diagnosed in PMTCT programs versus hospital. Results Among 1,923 HIV-exposed infants, HIV prevalence was higher among infants tested in hospital than PMTCT early infant diagnosis (EID) sites (41% vs. 11%, p < 0.001); the number of HIV-exposed infants needed to test to diagnose one infection was 2.4 in the hospital vs. 9.1 in PMTCT. Receipt of HIV test results was faster among hospitalized infants (7 vs. 25 days, p < 0.001). Infants diagnosed in hospital were older at the time of testing than PMTCT diagnosed infants (5.0 vs. 1.6 months, respectively, p < 0.001). In the subset of 99 HIV-infected infants <4.5 months old followed longitudinally, hospital-diagnosed infants did not differ from PMTCT-diagnosed infants in time to ART initiation; however, hospital-diagnosed infants were >3 times as likely to die (HR = 3.1, 95% CI = 1.3-7.6). Conclusions Among HIV-exposed infants, hospital-based testing was more likely to detect an HIV-infected infant than PMTCT testing. Because young symptomatic infants diagnosed with HIV during hospitalization have very high mortality, every effort should be made to diagnose HIV infections before symptom onset. Systems to expedite turnaround time at PMTCT EID sites and to routinize inpatient pediatric HIV testing are necessary to improve pediatric HIV outcomes.
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Affiliation(s)
- Anjuli Wagner
- Department of Epidemiology, University of Washington, Box 359300, Seattle, WA, 98104, USA.
| | - Jennifer Slyker
- Department of Global Health, University of Washington, Box 359931, Seattle, WA, 98104, USA.
| | - Agnes Langat
- Centers for Disease Control and Prevention (CDC), Mbagathi Road, P.O. Box 54840, Nairobi, 00200, Kenya.
| | - Irene Inwani
- Kenyatta National Hospital, Ngong Road, Nairobi, 00202, Kenya.
| | - Judith Adhiambo
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676, Nairobi, 00202, Kenya.
| | - Sarah Benki-Nugent
- Department of Medicine, University of Washington, Box 359931, Seattle, WA, 98104, USA.
| | - Ken Tapia
- Department of Global Health, University of Washington, Box 359931, Seattle, WA, 98104, USA.
| | - Irene Njuguna
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676, Nairobi, 00202, Kenya.
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676, Nairobi, 00202, Kenya.
| | - Grace John-Stewart
- Departments of Global Health, Medicine, Epidemiology & Pediatrics, University of Washington, Box 359909, Seattle, WA, 98104, USA.
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Improved identification and enrolment into care of HIV-exposed and -infected infants and children following a community health worker intervention in Lilongwe, Malawi. J Int AIDS Soc 2015; 18:19305. [PMID: 25571857 PMCID: PMC4287633 DOI: 10.7448/ias.18.1.19305] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early identification and entry into care is critical to reducing morbidity and mortality in children with HIV. The objective of this report is to describe the impact of the Tingathe programme, which utilizes community health workers (CHWs) to improve identification and enrolment into care of HIV-exposed and -infected infants and children. METHODS Three programme phases are described. During the first phase, Mentorship Only (MO) (March 2007-February 2008) on-site clinical mentorship on paediatric HIV care was provided. In the second phase, Tingathe-Basic (March 2008-February 2009), CHWs provided HIV testing and counselling to improve case finding of HIV-exposed and -infected children. In the final phase, Tingathe-PMTCT (prevention of mother-to-child transmission) (March 2009-February 2011), CHWs were also assigned to HIV-positive pregnant women to improve mother-infant retention in care. We reviewed routinely collected programme data from HIV testing registers, patient mastercards and clinic attendance registers from March 2005 to March 2011. RESULTS During MO, 42 children (38 HIV-infected and 4 HIV-exposed) were active in care. During Tingathe-Basic, 238 HIV-infected children (HIC) were newly enrolled, a six-fold increase in rate of enrolment from 3.2 to 19.8 per month. The number of HIV-exposed infants (HEI) increased from 4 to 118. During Tingathe-PMTCT, 526 HIC were newly enrolled over 24 months, at a rate of 21.9 patients per month. There was also a seven-fold increase in the average number of exposed infants enrolled per month (9.5-70 patients per month), resulting in 1667 enrolled with a younger median age at enrolment (5.2 vs. 2.5 months; p < 0.001). During the Tingathe-Basic and Tingathe-PMTCT periods, CHWs conducted 44,388 rapid HIV tests, 7658 (17.3%) in children aged 18 months to 15 years; 351 (4.6%) tested HIV-positive. Over this time, 1781 HEI were enrolled, with 102 (5.7%) found HIV-infected by positive PCR. Additional HIC entered care through various mechanisms (including positive linkage by CHWs and transfer-ins) such that by February 2011, a total of 866 HIC were receiving care, a 23-fold increase from 2008. CONCLUSIONS A multipronged approach utilizing CHWs to conduct HIV testing, link HIC into care and provide support to PMTCT mothers can dramatically improve the identification and enrolment into care of HIV-exposed and -infected children.
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Penazzato M, Revill P, Prendergast AJ, Collins IJ, Walker S, Elyanu PJ, Sculpher M, Gibb DM. Early infant diagnosis of HIV infection in low-income and middle-income countries: does one size fit all? THE LANCET. INFECTIOUS DISEASES 2014; 14:650-5. [PMID: 24456814 DOI: 10.1016/s1473-3099(13)70262-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Despite expansion of services for prevention of mother-to-child transmission of HIV (PMTCT), about 700 infants acquire HIV every day. Early initiation of antiretroviral therapy for HIV-infected infants reduces mortality but requires diagnosis by virological testing, which is complex, expensive, and inaccessible in many settings. Little cost-effectiveness evidence exists about different strategies to deliver early infant diagnosis services. Cost-effectiveness will vary depending on entry points for testing, underlying prevalences of HIV, PMTCT coverage, treatment availability, programme attrition, and other factors. Appropriate policy responses are therefore context-specific. In most cases, early infant diagnosis should be concentrated at entry points where underlying infant HIV prevalence is highest (eg, malnutrition wards). This strategy contrasts with the tendency at present to test mainly within PMTCT programmes. If testing is undertaken in PMTCT programmes with high coverage, addition of a virological test at birth might have advantages, including greater predictive value, earlier diagnosis, and better infant follow-up. National programme managers should recognise the opportunity costs of the limited resources available, acknowledge the changing scenario of PMTCT scale-up, ensure implementation of provider-initiated testing and counselling, and tailor early infant diagnosis programmes to maximise health gains for children.
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Affiliation(s)
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Andrew J Prendergast
- MRC Clinical Trials Unit, London, UK; Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Peter J Elyanu
- STD/AIDS Control Program, Ministry of Health, Kampala, Uganda
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
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Clinical versus rapid molecular HIV diagnosis in hospitalized African infants: a randomized controlled trial simulating point-of-care infant testing. J Acquir Immune Defic Syndr 2014; 66:e23-30. [PMID: 24326604 DOI: 10.1097/qai.0000000000000080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Many African infants fail to receive their diagnostic HIV molecular test results and subsequently, antiretroviral therapy (ART). To determine whether a point-of-care molecular HIV test increases ART access for hospitalized Malawian infants, we simulated a point-of-care test using rapid HIV RNA polymerase chain reaction (Rapid PCR) and compared patient outcomes with an optimized standard care that included assessment with the World Health Organization clinical algorithm for HIV infection plus a DNA PCR with a turnaround time of several weeks (standard care). DESIGN Randomized controlled trial. METHODS Hospitalized HIV-exposed Malawian infants aged <12 months were randomized into Rapid PCR or standard care. Rapid PCR infants obtained molecular test results within 48 hours to facilitate immediate ART, similar to a point-of-care test. Standard care infants meeting clinical criteria were also offered inpatient ART. The primary outcome was appropriate in-hospital ART for DNA or RNA PCR-confirmed HIV-infected infants. RESULTS Three hundred infants were enrolled. A greater proportion of HIV-infected infants receiving Rapid PCR, versus standard care, started inpatient ART (72.3% vs 47.8%, P = 0.016). Among molecular test-negative infants, 26.9% receiving standard care unnecessarily initiated inpatient ART, versus 0.0% receiving Rapid PCR (P < 0.001). Rapid PCR modestly reduced the median days to ART (3.0 vs 6.5, P = 0.001) but did not influence outpatient follow-up for HIV-infected infants (78.1% vs 82.4%, P = 0.418). CONCLUSIONS Rapid PCR, versus an optimized standard care, increased the proportion of hospitalized HIV-infected infants initiating ART and reduced ART exposure in molecular test-negative infants, without meaningfully impacting time to ART initiation or follow-up rates.
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Wallace A, Kimambo S, Dafrossa L, Rusibamayila N, Rwebembera A, Songoro J, Arthur G, Luman E, Finkbeiner T, Goodson JL. Qualitative assessment of the integration of HIV services with infant routine immunization visits in Tanzania. J Acquir Immune Defic Syndr 2014; 66:e8-e14. [PMID: 24326602 PMCID: PMC4663663 DOI: 10.1097/qai.0000000000000078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2009, a project was implemented in 8 primary health clinics throughout Tanzania to explore the feasibility of integrating pediatric HIV prevention services with routine infant immunization visits. METHODS We conducted interviews with 64 conveniently sampled mothers of infants who had received integrated HIV and immunization services and 16 providers who delivered the integrated services to qualitatively identify benefits and challenges of the intervention midway through project implementation. FINDINGS Mothers' perceived benefits of the integrated services included time savings, opportunity to learn their child's HIV status and receive HIV treatment, if necessary. Providers' perceived benefits included reaching mothers who usually would not come for only HIV testing. Mothers and providers reported similar challenges, including mothers' fear of HIV testing, poor spousal support, perceived mandatory HIV testing, poor patient flow affecting confidentiality of service delivery, heavier provider workloads, and community stigma against HIV-infected persons; the latter a more frequent theme in rural compared with urban locations. INTERPRETATION Future scale-up should ensure privacy of these integrated services received at clinics and community outreach to address stigma and perceived mandatory testing. Increasing human resources for health to address higher workloads and longer waiting times for proper patient flow is necessary in the long term.
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Affiliation(s)
- Aaron Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sajida Kimambo
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Lyimo Dafrossa
- Expanded Programme on Immunizations, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Neema Rusibamayila
- Reproductive Child Health Services, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Anath Rwebembera
- National AIDS Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Juma Songoro
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Gilly Arthur
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Elizabeth Luman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thomas Finkbeiner
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - James L. Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
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Zoufaly A, Hammerl R, Sunjoh F, Jochum J, Nassimi N, Awasom C, Tayong G, Sauter F, Schmiedel S, van Lunzen J, Burchard G, Feldt T. High HIV prevalence among children presenting for general consultation in rural Cameroon. Int J STD AIDS 2014; 25:742-4. [PMID: 24469969 DOI: 10.1177/0956462413518762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Data on the HIV-prevalence children presenting to health care facilities in sub-Saharan Africa are scant in general, and the debate about opportunities for paediatric HIV screening is ongoing. Nine hundred and eighty-one children with unknown HIV-status presenting to a large general paediatric outpatient department in rural Cameroon were tested using the Determine HIV-1/2 rapid test (Abbott), and positive results were confirmed with the Hexagon HIV rapid test (Human Diagnostics). In children younger than 18 months, HIV infection was confirmed by PCR testing. Median age was 1.3 years and 52.8% were of male gender. In 514 children below 18 months of age, 16 (3.1%) tested positive. Of those, HIV-1 PCR was available for 11 children, of whom 6 had a positive PCR result. HIV prevalence was highest in the age group 5-9 years, being 8.8%. Malnutrition (33.3 vs 5.2%, p < 0.001) was associated with HIV infection. Our study results indicate that HIV testing should be offered to all children at possible entry points to medical care, irrespective of symptoms, in order to reduce HIV-associated mortality through timely initiation of antiretroviral therapy.
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Affiliation(s)
- A Zoufaly
- Infectious Diseases Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Hammerl
- Altona Children's Hospital, Hamburg, Germany
| | - F Sunjoh
- Bamenda Regional Hospital, Cameroon
| | - J Jochum
- Infectious Diseases Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Nassimi
- Bernhard Nocht Institute for Tropical Medicine, Clinical Research Unit, Hamburg, Germany
| | - C Awasom
- Bamenda Regional Hospital, Cameroon
| | - G Tayong
- Bamenda Regional Hospital, Cameroon
| | - F Sauter
- Bamenda Regional Hospital, Cameroon
| | - S Schmiedel
- Infectious Diseases Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J van Lunzen
- Infectious Diseases Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Burchard
- Bernhard Nocht Institute for Tropical Medicine, Clinical Research Unit, Hamburg, Germany
| | - T Feldt
- Bernhard Nocht Institute for Tropical Medicine, Clinical Research Unit, Hamburg, Germany Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
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The acceptability and feasibility of routine pediatric HIV testing in an outpatient clinic in Durban, South Africa. Pediatr Infect Dis J 2013; 32:1348-53. [PMID: 23694834 PMCID: PMC3895104 DOI: 10.1097/inf.0b013e31829ba34b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Limited access to HIV testing of children impedes early diagnosis and access to antiretroviral therapy. Our objective was to evaluate the feasibility and acceptability of routine pediatric HIV testing in an urban, fee-for-service, outpatient clinic in Durban, South Africa. METHODS We assessed the number of patients (0-15 years) who underwent HIV testing upon physician referral during a baseline period. We then established a routine, voluntary HIV testing study for pediatric patients, regardless of symptoms. Parents/caretakers were offered free rapid fingerstick HIV testing of their child. For patients <18 months, the biological mother was offered HIV testing and HIV DNA polymerase chain reaction was used to confirm the infant's status. The primary outcome was the HIV testing yield, defined as the average number of positive tests per month during the routine compared with the baseline period. RESULTS Over a 5-month baseline testing period, 931 pediatric patients registered for outpatient care. Of the 124 (13%) patients who underwent testing on physician referral, 21 (17%, 95% confidence interval: 11-25%) were HIV infected. During a 13-month routine testing period, 2790 patients registered for care and 2106 (75%) were approached for participation. Of these, 1234 were eligible and 771 (62%) enrolled. Among those eligible, 637 (52%, 95% confidence interval: 49-54%) accepted testing of their child or themselves (biological mothers of infants <18 months). There was an increase in the average number of HIV tests during the routine compared with the baseline HIV testing periods (49 versus 25 tests/month, P = 0.001) but no difference in the HIV testing yield during the testing periods (3 versus 4 positive HIV tests/month, P = 0.06). However, during the routine testing period, HIV prevalence remains extraordinarily high with 39 (6%, 95% confidence interval: 4-8%) newly diagnosed HIV-infected children (median 7 years, 56% female). CONCLUSIONS Targeted and symptom-based testing referral identifies an equivalent number of HIV-infected children as routine HIV testing. Routine HIV testing identifies a high burden of HIV and is a feasible and moderately acceptable strategy in an outpatient clinic in a high prevalence area.
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Ahmed S, Kim MH, Sugandhi N, Phelps BR, Sabelli R, Diallo MO, Young P, Duncan D, Kellerman SE. Beyond early infant diagnosis: case finding strategies for identification of HIV-infected infants and children. AIDS 2013; 27 Suppl 2:S235-45. [PMID: 24361633 DOI: 10.1097/qad.0000000000000099] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There are 3.4 million children infected with HIV worldwide, with up to 2.6 million eligible for treatment under current guidelines. However, roughly 70% of infected children are not receiving live-saving HIV care and treatment. Strengthening case finding through improved diagnosis strategies, and actively linking identified HIV-infected children to care and treatment is essential to ensuring that these children benefit from the care and treatment available to them. Without attention or advocacy, the majority of these children will remain undiagnosed and die from complications of HIV. In this article, we summarize the challenges of identifying HIV-infected infants and children, review currently available evidence and guidance, describe promising new strategies for case finding, and make recommendations for future research and interventions to improve identification of HIV-infected infants and children.
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Improved access to early infant diagnosis is a critical part of a child-centric prevention of mother-to-child transmission agenda. AIDS 2013; 27 Suppl 2:S197-205. [PMID: 24361629 DOI: 10.1097/qad.0000000000000104] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prevention-of-mother-to-child-transmission (PMTCT) programs have made it possible to achieve dramatic reductions in the rate of vertical HIV transmission. However, high attrition, particularly after delivery, has limited the impact of these interventions for HIV-exposed infants who remain at risk through the end of breastfeeding. DESIGN AND METHODS A review of current literature on early infant diagnosis (EID) testing and country experience in low-and middle-income countries. RESULTS While PMTCT programs report reduced rates of infection among infants tested at 2 months of age, too few services are focused on retention of HIV-exposed infants in care. An unacceptably large proportion of HIV-exposed and HIV-infected infants remain unidentified. While the complexities of EID have been simplified with the development of optimized commodities and tools to improve service delivery, the inaccessibility and inadequate uptake of EID services has resulted in lag of care for the millions of HIV-exposed infants who remain unidentified. Coverage of EID testing remains low and there are many HIV- infected infants or at risk of infection who may not enter the health system through PMTCT programs. Waiting for HIV-infected children to present sick is not an adequate strategy for identifying and linking infants to treatment. Several interventions suggest a potential to expand access to EID testing, while more aggressive testing strategies may ensure children can be captured at any point of contact with the health system. CONCLUSIONS Programs focused on preventing vertical transmission need to increase their commitment to child-centric interventions and broaden their measure of success to reflect infants who test negative at the end of the exposure period. This paper argues that EID is a key strategy to retaining HIV-exposed infants through the end of the exposure period, as it provides an opportunity to offer early clinical care and continuous follow up. It is imperative that maternal and child survival programs become sensitized to the urgency of early identification of HIV in infants and their retention in care.
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Ndondoki C, Brou H, Timite-Konan M, Oga M, Amani-Bosse C, Menan H, Ekouévi D, Leroy V. Universal HIV screening at postnatal points of care: which public health approach for early infant diagnosis in Côte d'Ivoire? PLoS One 2013; 8:e67996. [PMID: 23990870 PMCID: PMC3749176 DOI: 10.1371/journal.pone.0067996] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 05/29/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Universal HIV pediatric screening offered at postnatal points of care (PPOC) is an entry point for early infant diagnosis (EID). We assessed the parents' acceptability of this approach in Abidjan, Côte d'Ivoire. METHODS In this cross-sectional study, trained counselors offered systematic HIV screening to all children aged 6-26 weeks attending PPOC in three community health centers with existing access to HAART during 2008, as well as their parents/caregivers. HIV-testing acceptability was measured for parents and children; rapid HIV tests were used for parents. Both parents' consent was required according to the Ivorian Ethical Committee to perform a HIV test on HIV-exposed children. Free HIV care was offered to those who were diagnosed HIV-infected. FINDINGS We provided 3,013 HIV tests for infants and their 2,986 mothers. While 1,731 mothers (58%) accepted the principle of EID, only 447 infants had formal parental consent 15%; 95% confidence interval (CI): [14%-16%]. Overall, 1,817 mothers (61%) accepted to test for HIV, of whom 81 were HIV-infected (4.5%; 95% CI: [3.5%-5.4%]). Among the 81 HIV-exposed children, 42 (52%) had provided parental consent and were tested: five were HIV-infected (11.9%; 95% CI: [2.1%-21.7%]). Only 46 fathers (2%) came to diagnose their child. Parental acceptance of EID was strongly correlated with prenatal self-reported HIV status: HIV-infected mothers were six times more likely to provide EID parental acceptance than mothers reporting unknown or negative prenatal HIV status (aOR: 5.9; 95% CI: [3.3-10.6], p = 0.0001). CONCLUSIONS Although the principle of EID was moderately accepted by mothers, fathers' acceptance rate remained very low. Routine HIV screening of all infants was inefficient for EID at a community level in Abidjan in 2008. Our results suggest the need of focusing on increasing the PMTCT coverage, involving fathers and tracing children issued from PMTCT programs in low HIV prevalence countries.
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Affiliation(s)
- Camille Ndondoki
- Inserm, U897, Centre de Recherche Epidémiologie et Biostatistique, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Victor Segalen, Bordeaux, France
| | - Hermann Brou
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
| | - Marguerite Timite-Konan
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
- Service de Pédiatrie, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Maxime Oga
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
| | | | - Hervé Menan
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
- Laboratoire de Virologie du CeDRes, Abidjan, Côte d'Ivoire
| | - Didier Ekouévi
- Inserm, U897, Centre de Recherche Epidémiologie et Biostatistique, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Victor Segalen, Bordeaux, France
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
| | - Valériane Leroy
- Inserm, U897, Centre de Recherche Epidémiologie et Biostatistique, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Victor Segalen, Bordeaux, France
- * E-mail:
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Abstract
Scott Kellerman and colleagues argue that the scope of the current HIV elimination agenda must be broadened in order to ensure access to care and treatment for all children living with HIV. Please see later in the article for the Editors' Summary
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O'Donnell K, Yao J, Ostermann J, Thielman N, Reddy E, Whetten R, Maro V, Itemba D, Pence B, Dow D, Whetten K. Low rates of child testing for HIV persist in a high-risk area of East Africa. AIDS Care 2013; 26:326-31. [PMID: 23875966 DOI: 10.1080/09540121.2013.819405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Children in low- and middle-income countries (LMIC) are the least touched by recent successes in the diagnosis and treatment of HIV/AIDS globally. Early treatment is essential for a child's longer and higher quality of life; however, by 2011, only a small proportion of HIV-seropositive children in LMIC countries were receiving treatment, in part because of persisting low rates of diagnosis. This study of the prevalence and characteristics of children tested for HIV was embedded in the Coping with HIV/AIDS in Tanzania (CHAT) study in which HIV-seropositive and HIV-seronegative adults, and adults with unknown HIV status were asked about HIV testing for their children. Data were gathered from November 2009 to August 2010 during the scale-up of Prevention of Mother To Child Transmission and Early Infant Diagnosis programs in the region. Reports on 1776 children indicate that 31.7% of all children were reported to have been tested, including only 42.9% of children with an HIV-seropositive caregiver. In general, children more likely to be HIV tested were biological children of study participants, younger, of widowed adults, living in urban areas, and of HIV-seropositive parents/caregivers. Children belonging to the two indigenous tribes, Chagga and Pare, were more likely to be tested than those from other tribes. Rates of testing among children less than two years old were low, even for the HIV-seropositive caregiver group. The persistence of low testing rates is discussed in terms of the accessibility and acceptability of child testing in resource poor settings.
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Affiliation(s)
- Karen O'Donnell
- a Center for Health Policy and Inequalities Research, Duke Global Health Institute , Duke University , Durham , NC , USA
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Tukei VJ, Murungi M, Asiimwe AR, Migisha D, Maganda A, Bakeera-Kitaka S, Kalyesubula I, Musoke P, Kekitiinwa A. Virologic, immunologic and clinical response of infants to antiretroviral therapy in Kampala, Uganda. BMC Pediatr 2013; 13:42. [PMID: 23536976 PMCID: PMC3616823 DOI: 10.1186/1471-2431-13-42] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/22/2013] [Indexed: 11/23/2022] Open
Abstract
Background Antiretroviral therapy (ART) is known to save lives. Among HIV-infected infants living in resource constrained settings, the short and long term benefits of ART are only partially known. This study was designed to determine the virologic, immunologic and clinical outcomes of antiretroviral therapy in a cohort of HIV-infected infants receiving care from an outpatient clinic in Kampala, Uganda. Methods A prospective cohort of HIV-infected infants receiving treatment at the Baylor-Uganda clinic was analyzed. Patients were diagnosed, enrolled and followed up at the clinic. HIV viral load, CD4 cell counts and clinical progress were assessed during follow-up. Descriptive statistical analysis and logistic regression modeling to determine predictors of treatment success were conducted. Results Of 91 HIV-infected infants enrolled into the cohort, 53 (58.2%) infants were female; 43 (47.3%) were 6 months of age or younger, and 50 (55.6%) had advanced HIV/AIDS disease (Clinical stage 3 or 4). Eighty four infants started ART and 78 (92.9%) completed 6 months of treatments. Fifty six (71.8%) infants attained virologic suppression by month-6 of ART, and at month-12 of ART, the cumulative probability of attaining viral suppression was 83.1%. None of the baseline infant factors (age, sex, WHO stage, CD4 cell percent, weight for age, or height for age z-score) predicted treatment success. There was an increase in CD4 cells from a baseline mean of 23% to 30% at month-6 of treatment (p<0.001) and by month-24 of ART, the mean CD4 percent was 36%. A total of 7 patients died while on ART and another 7 experienced adverse events that were related to treatment. Conclusion Our results show that, even among very young patients from resource constrained settings, ART dramatically suppresses HIV replication, allows immune recovery and clinical improvement, and is safe. However, baseline characteristics do not predict recovery in this age group.
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Affiliation(s)
- Vincent J Tukei
- Baylor College of Medicine-Bristol Myers Squibb Children's Clinical Center of Excellence at Mulago Hospital, Kampala, Uganda.
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Superior uptake and outcomes of early infant diagnosis of HIV services at an immunization clinic versus an "under-five" general pediatric clinic in Malawi. J Acquir Immune Defic Syndr 2012; 60:e107-10. [PMID: 22614897 DOI: 10.1097/qai.0b013e31825aa721] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although the Malawian government recommends HIV-exposed infants receive early infant diagnosis (EID) of HIV at "under-five" pediatric clinics (U5Cs), most never enroll. Therefore, we evaluated the integration of EID testing into an immunization clinic (IC) compared with the current standard of EID testing at an U5C. DESIGN Prospective observational study. METHODS Using routine provider-initiated HIV testing and counseling (PITC) registers, we prospectively studied 1757 children offered PITC at a government IC and U5C. Infants tested by HIV DNA polymerase chain reaction (PCR) were followed until PCR result disclosure or defaulting. RESULTS We sampled 877 and 880 consecutive PITC recipients at U5C and IC, respectively. Overall, a 7-fold greater proportion received PITC at IC (84.2% vs. 11.4%, P < 0.001). PITC recipients at IC were more than 14 months younger (2.6 vs. 17.0, P < 0.001), with greater proportions HIV exposed (17.6% vs. 5.3%, P < 0.001) and PCR eligible (7.9% vs. 3.5%, P < 0.001). A higher percentage of IC infants accepted PCR testing (100.0% vs. 90.3%, P = 0.03). Additionally, IC PCR recipients were 2.5 months younger (3.1 vs. 5.6, P < 0.001) with 4 times less testing PCR positive (7.1% vs. 32.1%, P < 0.001). Importantly, a more than 3-fold greater proportion of HIV-exposed infants at IC returned for their PCR result and enrolled into care (78.6% vs. 25.0%, P < 0.001). CONCLUSIONS Compared with an U5C, integrating EID testing into an IC is more acceptable, more feasible, enrolls more infants into EID at younger ages, and would likely strengthen Malawi's EID services if expanded.
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Kim MH, Ahmed S, Buck WC, Preidis GA, Hosseinipour MC, Bhalakia A, Nanthuru D, Kazembe PN, Chimbwandira F, Giordano TP, Chiao EY, Schutze GE, Kline MW. The Tingathe programme: a pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi. J Int AIDS Soc 2012; 15 Suppl 2:17389. [PMID: 22789644 PMCID: PMC3499848 DOI: 10.7448/ias.15.4.17389] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 05/16/2012] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Loss to follow-up is a major challenge in the prevention of mother to child transmission of HIV (PMTCT) programme in Malawi with reported loss to follow-up of greater than 70%. Tingathe-PMTCT is a pilot intervention that utilizes dedicated community health workers (CHWs) to create a complete continuum of care within the PMTCT cascade, improving service utilization and retention of mothers and infants. We describe the impact of the intervention on longitudinal care starting with diagnosis of the mother at antenatal care (ANC) through final diagnosis of the infant. METHODS PMTCT service utilization, programme retention and outcomes were evaluated for pregnant women living with HIV and their exposed infants enrolled in the Tingathe-PMTCT programme between March 2009 and March 2011. Multivariate logistic regression was done to evaluate maternal factors associated with failure to complete the cascade. RESULTS Over 24 months, 1688 pregnant women living with HIV were enrolled. Median maternal age was 27 years (IQR, 23.8 to 30.8); 333 (19.7%) were already on ART. Among the remaining women, 1328/1355 (98%) received a CD4 test, with 1243/1328 (93.6%) receiving results. Of the 499 eligible for ART, 363 (72.8%) were successfully initiated. Prior to, delivery there were 93 (5.7%) maternal/foetal deaths, 137 (8.1%) women transferred/moved, 51 (3.0%) were lost and 58 (3.4%) refused ongoing PMTCT services. Of the 1318 live births to date, 1264 (95.9%) of the mothers and 1285 (97.5%) of the infants received ARV prophylaxis; 1064 (80.7%) infants were tested for HIV by PCR and started on cotrimoxazole. Median age at PCR was 1.7 months (IQR, 1.5 to 2.5). Overall transmission at first PCR was 43/1047 (4.1%). Of the 43 infants with positive PCR results, 36 (83.7%) were enrolled in ART clinic and 33 (76.7%) were initiated on ART. CONCLUSIONS Case management and support by dedicated CHWs can create a continuum of longitudinal care in the PMTCT cascade and result in improved outcomes.
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Affiliation(s)
- Maria H Kim
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Cherutich P, Kaiser R, Galbraith J, Williamson J, Shiraishi RW, Ngare C, Mermin J, Marum E, Bunnell R. Lack of knowledge of HIV status a major barrier to HIV prevention, care and treatment efforts in Kenya: results from a nationally representative study. PLoS One 2012; 7:e36797. [PMID: 22574226 PMCID: PMC3344943 DOI: 10.1371/journal.pone.0036797] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/06/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We analyzed HIV testing rates, prevalence of undiagnosed HIV, and predictors of testing in the Kenya AIDS Indicator Survey (KAIS) 2007. METHODS KAIS was a nationally representative sero-survey that included demographic and behavioral indicators and testing for HIV, HSV-2, syphilis, and CD4 cell counts in the population aged 15-64 years. We used gender-specific multivariable regression models to identify factors independently associated with HIV testing in sexually active persons. RESULTS Of 19,840 eligible persons, 80% consented to interviews and blood specimen collection. National HIV prevalence was 7.1% (95% CI 6.5-7.7). Among ever sexually active persons, 27.4% (95% CI 25.6-29.2) of men and 44.2% (95% CI 42.5-46.0) of women reported previous HIV testing. Among HIV-infected persons, 83.6% (95% CI 76.2-91.0) were unaware of their HIV infection. Among sexually active women aged 15-49 years, 48.7% (95% CI 46.8-50.6) had their last HIV test during antenatal care (ANC). In multivariable analyses, the adjusted odds ratio (AOR) for ever HIV testing in women ≥35 versus 15-19 years was 0.2 (95% CI: 0.1-0.3; p<0.0001). Other independent associations with ever HIV testing included urban residence (AOR 1.6, 95% CI: 1.2-2.0; p = 0.0005, women only), highest wealth index versus the four lower quintiles combined (AOR 1.8, 95% CI: 1.3-2.5; p = 0.0006, men only), and an increasing testing trend with higher levels of education. Missed opportunities for testing were identified during general or pregnancy-specific contacts with health facilities; 89% of adults said they would participate in home-based HIV testing. CONCLUSIONS The vast majority of HIV-infected persons in Kenya are unaware of their HIV status, posing a major barrier to HIV prevention, care and treatment efforts. New approaches to HIV testing provision and education, including home-based testing, may increase coverage. Targeted interventions should involve sexually active men, sexually active women without access to ANC, and rural and disadvantaged populations.
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Affiliation(s)
- Peter Cherutich
- National AIDS/STI Control Programme (NASCOP), Nairobi, Kenya
| | - Reinhard Kaiser
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- * E-mail:
| | - Jennifer Galbraith
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Williamson
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carol Ngare
- National AIDS/STI Control Programme (NASCOP), Nairobi, Kenya
| | - Jonathan Mermin
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Marum
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Rebecca Bunnell
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Attitudes and practices of health care workers toward routine HIV testing of infants in Côte d'Ivoire: the PEDI-TEST ANRS 12165 Project. J Acquir Immune Defic Syndr 2011; 57 Suppl 1:S16-21. [PMID: 21857280 DOI: 10.1097/qai.0b013e31821fd487] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We assessed attitudes and practices of health care workers (HCWs) toward HIV counselling and testing (CT) routinely offered to infants in health facilities in Abidjan, Côte d'Ivoire. METHODS We performed a cross-sectional survey inquiring on systematic HIV CT offered to children aged 6-26 weeks attending postnatal care for either immunization or pediatric care and to their parents in 4 community health centres rolling-out access to antiretroviral therapy. Data were collected using standardized anonymous self-questionnaires directed to all HCWs involved. RESULTS One-hundred five HCWs were interviewed in 2008: 30% were social workers, 27% physicians, 24% nurses and 19% laboratory technicians. Among immunization staff (n = 45), none trained in child CT versus 26% in pediatric services (n = 60, P < 0001). Almost all staff believed that it is important to offer HIV screening services to children and the best place could be during pediatric consultations. In their daily work, 22% of immunization staff and 48% of pediatric care staff had already been dealing with early HIV CT (P = 0.01). Facing a child suspected to be HIV infected, only 54% of providers in pediatrics and 71% in immunization would offer CT to all family members (P = 0.01). CONCLUSIONS In Abidjan, although HCWs were generally in favour of pediatric HIV screening, very few had received specific training to do so. Deleguation of CT to the primary care level could improve coverage of CT services. It is urgent to train HCWs to promote early infant HIV diagnosis to improve earlier access to antiretroviral therapy in West African HIV-infected children.
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Chhagan MK, Kauchali S, Arpadi SM, Craib MH, Bah F, Stein Z, Davidson LL. Failure to test children of HIV-infected mothers in South Africa: implications for HIV testing strategies for preschool children. Trop Med Int Health 2011; 16:1490-4. [PMID: 21883725 DOI: 10.1111/j.1365-3156.2011.02872.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the uptake of HIV testing among preschool children with HIV-positive mothers in a peri-urban population-based study in KwaZulu-Natal, South Africa, an area of high HIV prevalence. METHODS All children 4-6 years old and their primary caregivers from the area were invited to participate. All participants were asked about prior HIV testing and were offered counselling and voluntary HIV testing irrespective of previous testing. Twenty-seven HIV-infected mothers were interviewed to identify barriers to testing their children. RESULTS One thousand five hundred and eighty-three children (88% of eligible children) and their caregivers participated. Of the biological mothers, 86% were previously tested for HIV (27% tested positive). Among the surviving 244 children born to an infected mother, only 41% had been tested for HIV (23% tested positive). Subsequently, 90% of previously untested children of infected mothers underwent HIV testing (9.3% were positive). Overall seroprevalence among study children was 4.9%. All infected mothers interviewed endorsed the belief that children of HIV-infected women should be tested for HIV. Women who missed opportunities for antenatal HIV testing reported no systematic testing of their children at later ages. CONCLUSIONS In this community with high HIV prevalence, HIV testing of children is infrequent despite high testing coverage among caregivers. The low proportion of children tested for HIV, particularly those of infected mothers, is of great concern as they are at high risk for morbidity and mortality associated with untreated childhood HIV infection. HIV testing programs should strengthen protocols to include children, especially for those who missed PMTCT opportunities in infancy.
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Affiliation(s)
- Meera K Chhagan
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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HIV prevalence and impact on renutrition in children hospitalised for severe malnutrition in Niger: an argument for more systematic screening. PLoS One 2011; 6:e22787. [PMID: 21829514 PMCID: PMC3145755 DOI: 10.1371/journal.pone.0022787] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 06/30/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In developing countries, malnutrition is a contributing factor in over 50% of child deaths. Mortality rates are higher in underweight children, and HIV-infection is known to increase underweight. Our goals were to evaluate the prevalence of HIV among children hospitalised for severe malnutrition (SM) at the Niamey national hospital (Niger), and to compare renutrition and mortality by HIV-status. METHODS Retrospective study based on all children <5 years hospitalised for SM between January 1(st) 2008 and July 1(st) 2009. HIV-prevalence was the ratio of HIV+ children on the number of children tested. Duration of renutrition and mortality were described using survival curves. RESULTS During the study period, 477 children were hospitalised for SM. HIV testing was accepted in 470 (98.5%), of which 40 were HIV+ (HIV prevalence (95% confidence interval) of 8.6% (6.2-11.5)). Duration of renutrition was longer in HIV+ than HIV- children (mean: 22 vs. 15 days; p = 0.003). During renutrition, 8 (20%) and 61 (14%) HIV+ and HIV- children died, respectively (p = 0.81). CONCLUSION Around 9% of children hospitalised for severe malnutrition were HIV infected, while in Niger HIV prevalence in adults is estimated at 0.8%. This pleads for wider access to HIV testing in this population.
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Ciaranello AL, Park JE, Ramirez-Avila L, Freedberg KA, Walensky RP, Leroy V. Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions. BMC Med 2011; 9:59. [PMID: 21599888 PMCID: PMC3129310 DOI: 10.1186/1741-7015-9-59] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/20/2011] [Indexed: 02/07/2023] Open
Abstract
Early infant diagnosis (EID) of HIV-1 infection confers substantial benefits to HIV-infected and HIV-uninfected infants, to their families, and to programs providing prevention of mother-to-child transmission (PMTCT) services, but has been challenging to implement in resource-limited settings. In order to correctly inform parents/caregivers of infant infection status and link HIV-infected infants to care and treatment, a 'cascade' of events must successfully occur. A frequently cited barrier to expansion of EID programs is the cost of the required laboratory assays. However, substantial implementation barriers, as well as personnel and infrastructure requirements, exist at each step in the cascade. In this update, we review challenges to uptake at each step in the EID cascade, highlighting that even with the highest reported levels of uptake, nearly half of HIV-infected infants may not complete the cascade successfully. We next synthesize the available literature about the costs and cost effectiveness of EID programs; identify areas for future research; and place these findings within the context of the benefits and challenges to EID implementation in resource-limited settings.
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Affiliation(s)
- Andrea L Ciaranello
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Ji-Eun Park
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lynn Ramirez-Avila
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Children's Hospital Boston, Boston, MA, USA
| | - Kenneth A Freedberg
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research, Harvard Medical School, Boston, MA, USA
| | - Rochelle P Walensky
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research, Harvard Medical School, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Valeriane Leroy
- Inserm, Unité 897, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Segalen, Bordeaux, France
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