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

Kiyaga, Charles; Urick, Brittany; Fong, Youyi; Okiira, Christopher; Nabukeera-Barungi, Nicolette; Nansera, Denis; Ochola, Emmanuel; Nteziyaremye, Julius; Bigira, Victor; Ssewanyana, Isaac; Peter, Trevor; Ghadrshenas, Anisa; Vojnov, Lara

doi:10.1002/jia2.25089

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…Other studies have shown that inpatient and nutrition services are where infected children are found [37]. Expanding routine early infant diagnosis screening beyond the traditional PMTCT setting to outpatient and inpatient entry points will increase the identification of HIV-infected infants.…”

Section: Discussionmentioning

confidence: 99%

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

Nkenfou,

Nguefack-Tsague,

Nanfack

et al. 2024

Viruses

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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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Section: Discussionmentioning

confidence: 99%

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

Nkenfou,

Nguefack-Tsague,

Nanfack

et al. 2024

Viruses

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“…Even when testing coverage is relatively high, our sensitivity analyses show that further improving knowledge of HIV status has a substantial impact on reducing undiagnosed prevalence. Additionally, results suggest that because pregnant/breastfeeding women who are not on ART are likely to not be engaged with HIV services, testing children for HIV outside of formal infant testing programmes is critical [ 41 , 42 , 43 ]. Programmes offering routine, provider‐initiated HIV testing in medical settings outside of traditional pathways, such as nutrition, immunization, inpatient and TB clinics, have been found effective in identifying undiagnosed CLWH [ 41 , 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, results suggest that because pregnant/breastfeeding women who are not on ART are likely to not be engaged with HIV services, testing children for HIV outside of formal infant testing programmes is critical [ 41 , 42 , 43 ]. Programmes offering routine, provider‐initiated HIV testing in medical settings outside of traditional pathways, such as nutrition, immunization, inpatient and TB clinics, have been found effective in identifying undiagnosed CLWH [ 41 , 43 , 44 ]. A recent study offering routine HIV testing for infants up to 24 months of age in Uganda found that nutrition clinics have the highest undiagnosed HIV prevalence (9.8%), followed by traditional infant testing (3.8%), inpatient (3.5%), outreach (1.7%) and immunization (0.8%) settings, highlighting that settings frequented by younger and/or sicker children will have higher undiagnosed prevalence than general population settings (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study offering routine HIV testing for infants up to 24 months of age in Uganda found that nutrition clinics have the highest undiagnosed HIV prevalence (9.8%), followed by traditional infant testing (3.8%), inpatient (3.5%), outreach (1.7%) and immunization (0.8%) settings, highlighting that settings frequented by younger and/or sicker children will have higher undiagnosed prevalence than general population settings (e.g. households or schools) [ 41 , 42 , 43 ]. Still, HIV testing coverage in high‐yield sites may be low [ 36 ]; programmes should focus on maximizing coverage at these sites to increase the number of CLWH diagnosed.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes

et al. 2022

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Introduction To improve the diagnosis and survival of children living with HIV (CLWH), the World Health Organization recommends testing approaches beyond traditional infant HIV testing programmes. Information about undiagnosed HIV prevalence among children of varying ages in the general population is needed to guide innovative national/subnational case‐finding and testing approaches. Methods We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐Pediatric model to estimate the prevalence of undiagnosed HIV in 2‐, 5‐ and 10‐year‐old children in South Africa, Côte d'Ivoire and Zimbabwe in 2018. We simulated cohorts of children born in 2008 (10‐year‐olds), 2013 (5‐year‐olds) and 2016 (2‐year‐olds). Country‐/year‐specific inputs for pregnant/breastfeeding women included: HIV prevalence (4.2–32.3%), HIV incidence (0.03–0.24%/month), knowledge of HIV status (27–89%) and antiretroviral drug coverage (36–95%). Paediatric inputs included early infant testing coverage (6–95%) and breastfeeding duration (0–20 months). We projected the proportion of surviving CLWH in whom HIV remained undiagnosed and the undiagnosed HIV prevalence among surviving children of each age in the general population. For children born in 2016, we projected survival and diagnosis of all CLWH through 2026. We conducted sensitivity analyses on model parameters. Results In 2018, the projected proportion of surviving CLWH whose HIV remained undiagnosed in South Africa/Côte d'Ivoire/Zimbabwe was 44.2%/55.8%/52.9% among 2‐year‐old CLWH; 29.0%/37.8%/33.2% among 5‐year‐old CLWH; and 18.3%/25.4%/23.1% among 10‐year‐old CLWH. Projected general population undiagnosed HIV prevalence in South Africa/Côte d'Ivoire/Zimbabwe was 0.44%/0.32%/0.68% among 2‐year‐olds; 0.25%/0.17%/0.41% among 5‐year‐olds; and 0.24%/0.14%/0.38% among 10‐year‐olds. Among all CLWH born in 2016, 50–54% were projected to die without HIV diagnosis (and subsequently without treatment) within 10 years after birth; 80–85% of these deaths occurred in the first 2 years. Conclusions Projected population‐level undiagnosed HIV prevalence is low and sharply decreases after age 2, with more CLWH dying than being diagnosed. Despite low undiagnosed prevalence in the general population of older children, we project that a large proportion of CLWH remain undiagnosed, suggesting that innovative strategies targeting untested children of all ages outside of health facility settings should be prioritized. Programmes could consider routine testing of the general population of children below 2 in all settings and children of all ages in high‐prevalence settings.

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“…The potential for a false-positive result is of increasing concern as prevalence or transmission rates decrease. 3,4 For example, in a setting with mother-to-child transmission rates of less than 5%, the positive predictive value of a highly sensitive nucleic acid-based technology decreased to nearly 70%. 5 Fortunately, newer assays currently in use in the field have higher specificities with less dramatic decreases in positive predictive values.…”

mentioning

confidence: 99%

Implementing an Indeterminate Range for More Accurate Early Infant Diagnosis

Vojnov

Penazzato

Sherman³

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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

Cited by 9 publications

References 24 publications

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

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

Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes

Implementing an Indeterminate Range for More Accurate Early Infant Diagnosis

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