High HIV prevalence among children presenting for general consultation in rural Cameroon

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.

Active case finding: comparison of the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated-testing and counseling of HIV among children and adolescents in Cameroon

“…The HIV prevalence (4.3%) in the general population in Cameroon (4.3%) [ 17 ] is lower compared to Malawi (9.2%) and Kenya (5.4%) [ 8 ] and this may explain the lower HIV positivity rate observed among the pediatric and adolescent population in our study compared to Malawi and Kenya as reported in the aforementioned studies. In the bPITC group, we found a prevalence of 1.6%, which was similar to the 1.8% reported by Zoufaly et al in rural Cameroon [ 18 ] and closer to the 2.7% reported by Cohn et al in a meta-analysis [ 19 ].…”

Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis

“…7 Paediatric inpatient programmes were the most common context (17), 6,7,10,[13][14][15][16][17][18][19][21][22][23][24][25]29,30 followed by nutrition centres (four), 9,11,12,27 EPI centres (three), 20 programmes (three). 8,20,31 The assessment for quality showed that most of the included studies (20) [9][10][11][12][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31] were of fair or good quality and the remainder (six) [6][7][8]13,…”

“…9,23,28,31 Paediatric HIV prevalence across contexts in southern and eastern Africa was 17·8% (95% CI 12·8-22·7) and prevalence in west and central Africa was 9·8% (95% CI 4·2-15·3). Because of the small numbers of studies from Asia and Oceania, these geographical settings were not included in stratifi ed analyses.…”

“…6,9,11,12,16,18-20,22,26,29,31 11 of these studies were from sub-Saharan Africa 9,11,12,16,18-20,22,26,29,31 and one was from India. 6 These studies examined inpatient settings (six), 6,16,18,19,22,29 nutrition centres (three), 9,11,13 EPI centres (two), 20,26 and outpatient settings (two), 20,31 with one study examining both outpatient and EPI centres. 20 The unweighted mean for caregiver acceptance across twelve studies (13 settings) was 92·2% (range 73-100).…”

Where have all the children gone? High HIV prevalence in infants attending nutrition and inpatient entry points

“…While previous studies provided clues to the highest impact entry points for identifying HIV‐positive infants , these findings present the first evidence of differences in HIV prevalence amongst children accessing care at different health facility entry points in a low resource, generalized HIV epidemic. These data demonstrate high HIV prevalence among infants presenting for care at nutrition, inpatient, and PMTCT entry points.…”