Testing children of mothers with HIV infection: experience in three south‐west London HIV clinics

Abstract

ObjectiveThere are several reported cases of vertically infected children presenting with advanced HIV infection in the UK. The children of women with HIV infection are at increased risk of being infected. There are few data available on the number of such children that are yet to be tested for HIV. This study looked at the HIV testing status of children whose mothers attend HIV services at three south-west London clinics. MethodsCase notes of women attending the clinics from 1 January to 30 June 2009 were reviewed. When data were incomplete, women were prospectively interviewed. ResultsCase notes of 605 women were reviewed; 478 women had 1107 children. The majority of women (386; 81%) were of Black African ethnicity. Sixty-one per cent (675 of 1107) of the children were known to have been tested for HIV. The children resident abroad were more likely to be untested compared with those resident in the UK; 186 of 255 (73%) vs. 246 of 852 (29%). A quarter (106 of 432) of the untested children were 18 years old; 49 (46%) of these were resident in the UK. The most common reason given by the mothers for not testing was a perceived 'unlikely risk'. ConclusionsA significant number of children at risk of vertically transmitted HIV infection, including 49 children 18 years and resident in the UK, were identified through this study. The mothers are being encouraged to have these children tested and a multidisciplinary team involving adult and paediatric HIV healthcare professionals has been set up to negotiate and facilitate testing.

Mothers’ reasons for refusing to give consent to do HIV testing and the outcome in the children

“…In high-income countries, mothers who refused HIV testing for their children have cited various reasons, including: the perception that a physically well child cannot be infected with HIV, inability to cope with a positive diagnosis in a child, and feeling of guilt if the child tested positive. [26,27] In the present study, the main reason mothers refused HIV testing of their children was that they did not want to be stressed by the positive HIV result of the child.…”

Testing the children of HIV-infected parents: 6 years on from ‘Don't forget the children’

“…All mothers in the study had previously declined the offer to test their children for HIV, often citing a perception that their children were healthy and did not need testing as the main reason for refusal 13. Other reported barriers are a fear of unmasking their own HIV status should the child test positive and the child being abroad or uncontactable 14. Making testing routinely available in the context of family clinics15 or the use of point of care testing16 may facilitate increased testing coverage.…”

“…The largest of these studies looked at 605 predominantly black African women attending three HIV clinics in South London 14. Seventy-nine per cent of these women had 1107 children of whom 61% were known to have had a HIV test and 23% were resident abroad.…”