Beyond early infant diagnosis

Ahmed, Saeed; Kim, Maria; Sugandhi, Nandita; Phelps, B. Ryan; Sabelli, Rachael; Diallo, Mamadou Hassimiou; Young, Paul R.; Duncan, Dana; Kellerman, Scott E.

doi:10.1097/qad.0000000000000099

Cited by 57 publications

(66 citation statements)

References 80 publications

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“…This includes providerinitiated HIV-testing in paediatric wards and TB programmes in high-prevalence areas, with its well-described efficiency to identify previously undiagnosed children, although mortality in these children remains high due to late diagnosis (Ahmed et al, 2013;Kankasa et al, 2009;Mutanga et al, 2012). In our study majority of children were referred with advanced disease from hospital inpatient services (61%), with resultant high death rate (9% within six months).…”

Section: Discussionmentioning

confidence: 99%

“…Multiple entry points for paediatric HIV-testing are needed, guided by a clear strategy on paediatric case finding outside of PMTCT testing (Ahmed et al, 2013). This includes providerinitiated HIV-testing in paediatric wards and TB programmes in high-prevalence areas, with its well-described efficiency to identify previously undiagnosed children, although mortality in these children remains high due to late diagnosis (Ahmed et al, 2013;Kankasa et al, 2009;Mutanga et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Advances in antiretroviral therapy (ART) now enable good outcomes for HIV-infected children if therapy is initiated early (Violari et al, 2008). The South African ART programme commenced in 2004, cumulatively enrolling large numbers of adults on treatment, whereas paediatric ART access has lagged behind, similar to other SubSaharan countries (Ahmed et al, 2013;DOH, 2004;Johnson, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Identification of children missed by PMTCT testing has received less attention, like those with early symptomatic disease potentially identified at primary healthcare through the Integrated Management of Childhood Illnesses (IMCI) programme (DOH, 2011). Targeted testing of children of HIV-infected adults, sibling testing of known HIV-infected children and systematic testing within malnutrition and tuberculosis (TB) programmes furthermore requires high priority (Ahmed et al, 2013;Kellerman & Essajee, 2010). Meticulous documentation on patient-held records, like the South African Road-to-Health Card/Booklet (RTHC/RTHB), can further contribute towards earlier identification and testing of at-risk children (Horwood, Voce, Vermaak, Rollins & Qazi, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Diagnostic strategies should identify and test at-risk children and establish linkages to care (Ahmed et al, 2013). Extensive focus on testing HIV-exposed children from the PMTCT programme has resulted in steadily increasing HIV DNA PCR testing numbers, with majority of tests yielding negative results .…”

Section: Introductionmentioning

confidence: 99%

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Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

et al. 2015

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Post-print version. Full reference: 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. Published: AIDS Care. 2015. doi: 10.1080/09540121.2015.1066748 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 was reviewed of all children aged <15 years referred over a one-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one quarter (24.5%) were of school-going age, 34.5% in the preschool group, 18% between 6-12 months old and 23% below six months of age (median age=1.5 years [IQR 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 2 nd & 3 rd 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-toHealth 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

et al. 2015

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Point-of-care tests detecting HIV nucleic acids for diagnosis of HIV-1 or HIV-2 infection in infants and children aged 18 months or less

Ochodo

Guleid

Deeks

et al. 2021

Cochrane Database of Systematic Reviews

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Background The standard method of diagnosing HIV in infants and children less than 18 months is with a nucleic acid amplification test reverse transcriptase polymerase chain reaction test (NAT RT‐PCR) detecting viral ribonucleic acid (RNA). Laboratory testing using the RT‐PCR platform for HIV infection is limited by poor access, logistical support, and delays in relaying test results and initiating therapy in low‐resource settings. The use of rapid diagnostic tests at or near the point‐of‐care (POC) can increase access to early diagnosis of HIV infection in infants and children less than 18 months of age and timely initiation of antiretroviral therapy (ART). Objectives To summarize the diagnostic accuracy of point‐of‐care nucleic acid‐based testing (POC NAT) to detect HIV‐1/HIV‐2 infection in infants and children aged 18 months or less exposed to HIV infection. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (until 2 February 2021), MEDLINE and Embase (until 1 February 2021), and LILACS and Web of Science (until 2 February 2021) with no language or publication status restriction. We also searched conference websites and clinical trial registries, tracked reference lists of included studies and relevant systematic reviews, and consulted experts for potentially eligible studies. Selection criteria We defined POC tests as rapid diagnostic tests conducted at or near the patient site. We included any primary study that compared the results of a POC NAT to a reference standard of laboratory NAT RT‐PCR or total nucleic acid testing to detect the presence or absence of HIV infection denoted by HIV viral nucleic acids in infants and children aged 18 months or less who were exposed to HIV‐1/HIV‐2 infection. We included cross‐sectional, prospective, and retrospective study designs and those that provided sufficient data to create the 2 × 2 table to calculate sensitivity and specificity. We excluded diagnostic case control studies with healthy controls. Data collection and analysis We extracted information on study characteristics using a pretested standardized data extraction form. We used the QUADAS‐2 (Quality Assessment of Diagnostic Accuracy Studies) tool to assess the risk of bias and applicability concerns of the included studies. Two review authors independently selected and assessed the included studies, resolving any disagreements by consensus. The unit of analysis was the participant. We first conducted preliminary exploratory analyses by plotting estimates of sensitivity and specificity from each study on forest plots and in receiver operating characteristic (ROC) space. For the overall meta‐analyses, we pooled estimates of sensitivity and specificity using the bivariate meta‐analysis model at a common threshold (presence or absence of infection). Main results We identified a total of 12 studies (...

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HIV viral suppression and longevity among a cohort of children initiating antiretroviral therapy in Eastern Cape, South Africa

et al. 2018

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IntroductionThere are limited data on viral suppression (VS) in children with HIV receiving antiretroviral therapy (ART) in routine care in low‐resource settings. We examined VS in a cohort of children initiating ART in routine HIV care in Eastern Cape Province, South Africa.MethodsThe Pediatric Enhanced Surveillance Study enrolled HIV‐infected ART eligibility children zero to twelve years at five health facilities from 2012 to 2014. All children received routine HIV care and treatment services and attended quarterly study visits for up to 24 months. Time to VS among those starting treatment was measured from ART start date to first viral load (VL) result <1000 and VL <50 copies/mL using competing risk estimators (death as competing risk). Multivariable sub‐distributional hazards models examined characteristics associated with VS and VL rebound following suppression among those with a VL >30 days after the VS date.ResultsOf 397 children enrolled, 349 (87.9%) started ART: 118 (33.8%) children age <12 months, 122 (35.0%) one to five years and 109 (31.2%) six to twelve years. At study enrolment, median weight‐for‐age z‐score (WAZ) was −1.7 (interquartile range (IQR):−3.1 to −0.4) and median log VL was 5.6 (IQR: 5.0 to 6.2). Cumulative incidence of VS <1000 copies/mL at six, twelve and twenty‐four months was 57.6% (95% CI 52.1 to 62.7), 78.7% (95% CI 73.7 to 82.9) and 84.0% (95% CI 78.9 to 87.9); for VS <50 copies/mL: 40.3% (95% CI 35.0 to 45.5), 63.9% (95% CI 58.2 to 69.0) and 72.9% (95% CI 66.9 to 78.0). At 12 months only 46.6% (95% CI 36.6 to 56.0) of children <12 months had achieved VS <50 copies/mL compared to 76.9% (95% CI 67.9 to 83.7) of children six to twelve years (p < 0.001). In multivariable models, children with VL >1 million copies/mL at ART initiation were half as likely to achieve VS <50 copies/mL (adjusted sub‐distributional hazards 0.50; 95% CI 0.36 to 0.71). Among children achieving VS <50 copies/mL, 37 (19.7%) had VL 50 to 1000 copies/mL and 31 (16.5%) had a VL >1000 copies/mL. Children <12 months had twofold increased risk of VL rebound to VL >1000 copies/mL (adjusted relative risk 2.03, 95% CI: 1.10 to 3.74) compared with six to twelve year olds.ConclusionsWe found suboptimal VS among South African children initiating treatment and high proportions experiencing VL rebound, particularly among younger children. Greater efforts are needed to ensure that all children achieve optimal outcomes.

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Beyond early infant diagnosis

Cited by 57 publications

References 80 publications

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

Point-of-care tests detecting HIV nucleic acids for diagnosis of HIV-1 or HIV-2 infection in infants and children aged 18 months or less

HIV viral suppression and longevity among a cohort of children initiating antiretroviral therapy in Eastern Cape, South Africa

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