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

Cohn, Jennifer; Whitehouse, Katherine; Tuttle, Julia; Lueck, Kristin; Tran, Trang

doi:10.1016/s2352-3018(16)30050-9

Cited by 43 publications

(41 citation statements)

References 26 publications

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“…HIV testing within PMTCT programmes could be improved by addressing logistical challenges such as shortages of dried blood spot sample test kits [34]. Additionally, HIV testing could be performed in paediatric in-patient and out-patient clinics to ensure access to ART of HIV-positive children who dropped out of PMTCT programmes [35]. …”

Section: Discussionmentioning

confidence: 99%

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Haas

Oosterhout

Tenthani

et al. 2017

Journal of the International AIDS Society

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Introduction: In Malawi, HIV-infected pregnant and breastfeeding women are offered lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage (Option B+). Their HIV-exposed children are enrolled in the national prevention of mother-to-child transmission (PMTCT) programme, but many are lost to follow-up. We estimated the cumulative incidence of vertical HIV transmission, taking loss to follow-up into account. Methods: We abstracted data from HIV-exposed children enrolled into care between September 2011 and June 2014 from patient records at 21 health facilities in central and southern Malawi. We used competing risk models to estimate the probability of loss to follow-up, death, ART initiation and discharge, and used pooled logistic regression and inverse probability of censoring weighting to estimate the vertical HIV transmission risk. Results: A total of 11,285 children were included; 9285 (82%) were born to women who initiated ART during pregnancy. At age 30 months, an estimated 57.9% (95% CI 56.6–59.2) of children were lost to follow-up, 0.8% (0.6–1.0) had died, 2.6% (2.3–3.0) initiated ART, 36.5% (35.2–37.9) were discharged HIV-negative and 2.2% (1.5–2.8) continued follow-up. We estimated that 5.3% (95% CI 4.7–5.9) of the children who enrolled were HIV-infected by the age of 30 months, but only about half of these children (2.6%; 95% CI 2.3–2.9) were diagnosed. Conclusions: Confirmed mother-to-child transmission rates were low, but due to poor retention only about half of HIV-infected children were diagnosed. Tracing of children lost to follow-up and HIV testing in outpatient clinics should be scaled up to ensure that all HIV-positive children have access to early ART.

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Section: Discussionmentioning

confidence: 99%

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Haas

Oosterhout

Tenthani

et al. 2017

Journal of the International AIDS Society

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“…Of the 416 consenting adult index cases, 259 (66.6%) were on ART for more than one year, 258 (62.0%) were non-pregnant females and 299 (71.9%) had only primarylevel education. The median (IQR) age of the adults was 37 [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] years. The remaining 15 consenting were paediatric index cases.…”

Section: Index Cases and Uptake Of Hh-htcmentioning

confidence: 99%

“…However, routine facility-based testing efforts, including provider-initiated testing and counselling (PITC) and interventions that systematically track untested children of HIV-infected patients and provide referrals for testing, can increase paediatric HIV testing. These strategies remain an important method of identifying children and young persons living with HIV in areas where human resources are inadequate for home-based testing [10,19,32,[37][38][39][40].…”

Section: Despite Country and International Guidelines Thatmentioning

confidence: 99%

Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi

Ahmed

Sabelli²,

Simon

et al. 2017

Tropical Med Int Health

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ObjectivesEvaluation of a novel index case finding and linkage‐to‐care programme to identify and link HIV‐infected children (1–15 years) and young persons (>15–24 years) to care.MethodsHIV‐infected patients enrolled in HIV services were screened and those who reported untested household members (index cases) were offered home‐ or facility‐based HIV testing and counselling (HTC) of their household by a community health worker (CHW). HIV‐infected household members identified were enrolled in a follow‐up programme offering home and facility‐based follow‐up by CHWs.ResultsOf the 1567 patients enrolled in HIV services, 1030 (65.7%) were screened and 461 (44.8%) identified as index cases; 93.5% consented to HIV testing of their households and of those, 279 (64.7%) reported an untested child or young person. CHWs tested 711 children and young persons, newly diagnosed 28 HIV‐infected persons (yield 4.0%; 95% CI: 2.7–5.6), and identified an additional two HIV‐infected persons not enrolled in care. Of the 30 HIV‐infected persons identified, 23 (76.6%) were linked to HIV services; 18 of the 20 eligible for ART (90.0%) were initiated. Median time (IQR) from identification to enrolment into HIV services was 4 days (1–8) and from identification to ART start was 6 days (1–8).ConclusionsAlmost half of HIV‐infected patients enrolled in treatment services had untested household members, many of whom were children and young persons. Index case finding, coupled with home‐based testing and tracked follow‐up, is acceptable, feasible and facilitates the identification and timely linkage to care of HIV‐infected children and young persons.

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“…A recent multi-regional analysis has shown that many children in low-income countries start cART at severe immunosuppression levels (62% and 65% in girls and boys) compared to high income countries (21% and 28% in girls and boys) [12]. Reasons for the late start are manifold and several studies evaluated acceptance of HIV testing, linkage to care and cART initiation [13]. However, few reported long-term outcomes [14] and none provided cancer data.…”

Section: Epidemiology Of Cancer In Hiv-infected Childrenmentioning

confidence: 99%

HIV-associated malignancies in children

Singh

Naidu

Davies

et al. 2017

Current Opinion in HIV and AIDS

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Purpose of review HIV-infected children are at increased risk of developing cancer. Many of the cancers in HIV-infected children are linked to immunosuppression and oncogenic co-infections. Worldwide most HIV-infected children live in sub-Saharan Africa, but cancer data for this population are scarce. In this article we review the current literature on the epidemiology and prevention of cancer in HIV-infected children. Recent findings Combined antiretroviral therapy (cART) reduces the risk of developing cancer in HIV-infected children. Cancer risk remains increased in children who start cART at older ages or more advanced immunosuppression as compared to children who start cART at younger age and with mild immunosuppression. Starting cART before severe immunosuppression develops is key to prevent cancer in HIV-infected children but most children in low-income countries start cART at severe immunosuppression levels. Vaccination against high risk variants of human papilloma virus may protect again HPV-associated cancer later in life. However, tailoring of HPV-vaccination guidelines for HIV-infected children and young women awaits answers to determine the best vaccination strategies. Summary Better data on the short and long-term risk of developing cancer and the effects of preventive measures in HIV-infected children from regions with high burden of HIV/AIDS are urgently needed.

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

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

Cited by 43 publications

References 26 publications

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi

HIV-associated malignancies in children

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