Disease profile of children under 5 years attending primary health care clinics in a high HIV prevalence setting in South Africa

Horwood, Christiane; Butler, Lisa; Vermaak, Kerry; Rollins, Nigel; Haskins, Lyn; Nkosi, Phumla; Neilands, Torsten B.; Qazi, Shamim

doi:10.1111/j.1365-3156.2010.02672.x

Cited by 18 publications

(25 citation statements)

References 27 publications

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“…30 Our study also found a high HIV prevalence of 6% among children 0–15 years presenting to an outpatient clinic for acute medical services in the same province. Unlike previous routine HIV testing studies in the pediatric inpatient 9,10 and adult outpatient clinic setting, 20 we were unable to show an increase in the number of new HIV diagnoses per month.…”

Section: Discussionsupporting

confidence: 73%

The Acceptability and Feasibility of Routine Pediatric HIV Testing in an Outpatient Clinic in Durban, South Africa

Ramirez-Avila

Noubary

Pansegrouw³

et al. 2013

Pediatric Infectious Disease Journal

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Background Limited access to HIV testing of children impedes early diagnosis and access to antiretroviral therapy. Our objective was to evaluate the feasibility and acceptability of routine pediatric HIV testing in an urban, fee-for-service, outpatient clinic in Durban, South Africa. Methods We assessed the number of patients (0–15 years) who underwent HIV testing upon physician referral during a baseline period. We then established a routine, voluntary HIV testing study for pediatric patients, regardless of symptoms. Parents/caretakers were offered free rapid fingerstick HIV testing of their child. For patients <18 months, the biological mother was offered HIV testing and HIV DNA polymerase chain reaction was used to confirm the infant’s status. The primary outcome was the HIV testing yield, defined as the average number of positive tests per month during the routine compared with the baseline period. Results Over a 5-month baseline testing period, 931 pediatric patients registered for outpatient care. Of the 124 (13%) patients who underwent testing on physician referral, 21 (17%, 95% confidence interval: 11–25%) were HIV infected. During a 13-month routine testing period, 2790 patients registered for care and 2106 (75%) were approached for participation. Of these, 1234 were eligible and 771 (62%) enrolled. Among those eligible, 637 (52%, 95% confidence interval: 49–54%) accepted testing of their child or themselves (biological mothers of infants <18 months). There was an increase in the average number of HIV tests during the routine compared with the baseline HIV testing periods (49 versus 25 tests/month, P = 0.001) but no difference in the HIV testing yield during the testing periods (3 versus 4 positive HIV tests/month, P = 0.06). However, during the routine testing period, HIV prevalence remains extraordinarily high with 39 (6%, 95% confidence interval: 4–8%) newly diagnosed HIV-infected children (median 7 years, 56% female). Conclusions Targeted and symptom-based testing referral identifies an equivalent number of HIV-infected children as routine HIV testing. Routine HIV testing identifies a high burden of HIV and is a feasible and moderately acceptable strategy in an outpatient clinic in a high prevalence area.

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Section: Discussionsupporting

confidence: 73%

The Acceptability and Feasibility of Routine Pediatric HIV Testing in an Outpatient Clinic in Durban, South Africa

Ramirez-Avila

Noubary

Pansegrouw³

et al. 2013

Pediatric Infectious Disease Journal

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“…[9] The excessive numbers of children in our series with iNTS who were HIV-infected with PEM is concerning. HIV infection has been associated with undernourishment in children aged <5 years in South Africa, [29,30] and clearly remains problematic. This may be directly due to an HIV-associated effect in our study or due to other factors such as maternal illness or death.…”

Section: Discussionmentioning

confidence: 99%

Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South Africa

Keddy

Musekiwa²,

Sooka

et al. 2017

Medicine

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The aim of this study was to define factors associated with HIV-infected versus uninfected patients with invasive nontyphoidal Salmonella (iNTS) and factors associated with mortality, which are inadequately described in Africa.Laboratory-based surveillance for iNTS was undertaken. At selected sentinel sites, clinical data (age, sex, HIV status, severity of illness, and outcome) were collected.Surveillance was conducted in Gauteng, South Africa, from 2003 to 2013. Clinical and microbiological differences between HIV-infected and uninfected patients were defined and risk factors for mortality established.Of 4886 iNTS infections in Gauteng from 2003 to 2013, 3106 (63.5%) were diagnosed at sentinel sites. Among persons with iNTS infections, more HIV-infected persons were aged ≥5 years (χ2 = 417.6; P < 0.001) and more HIV-infected children were malnourished (χ2 = 5.8; P = 0.02). Although 760 (30.6%) patients died, mortality decreased between 2003 [97/263 (36.9%)] and 2013 [926/120 (21.7%)]. On univariate analysis, mortality was associated with patients aged 25 to 49 years [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.7–2.7; P < 0.001 and ≥50 years (OR = 3.0; 95% CI = 2.2–4.1; P < 0.001) compared with children < 5 years, HIV-infected patients (OR = 2.4; 95% CI = 1.7–3.4; P < 0.001), and severe illness (OR = 5.4; 95% CI = 3.6–8.1; P < 0.001). On multivariate analysis, mortality was associated with patients aged ≥50 years [adjusted OR (AOR) = 3.6, 95% CI = 2.1–6.1, P < 0.001] and severe illness (AOR = 6.3; 95% CI = 3.8–10.5; P < 0.001).Mortality due to iNTS in Gauteng remains high primarily due to disease severity. Interventions must be aimed at predisposing conditions, including HIV, other immune-suppressive conditions, and malignancy.

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“…6 HIV is thought to cause 9% of all child mortality in Kenya, 7 and many children with severe opportunistic illnesses and undiagnosed HIV infection continue to present to public health care facilities, as has been described elsewhere in Africa. 8 Field experience has shown that where pediatric ART is available, the response to treatment of children in low-income countries is as good as that observed in developed countries. 9 Thus, many HIV-related deaths among children living with HIV could be prevented through earlier diagnosis of HIV infection and early initiation of ART.…”

Section: Introductionmentioning

confidence: 99%

Burden of HIV Infection Among Children Aged 18 Months to 14 Years in Kenya

Ngeno

Mwangi

Ng’ang’a

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Backgrounds In Kenya, mathematical models estimate that there are approximately 220,000 children aged less than 15 years infected with HIV. We analyzed data from the second Kenya AIDS Indicator Survey (KAIS 2012) to estimate the prevalence of HIV infection among children aged 18 months to 14 years. Methods KAIS 2012 was a nationally representative 2-stage cluster sample household survey. We studied children aged 18 months to 14 years whose parents or guardians answered questions pertaining to their children by interview. Blood specimens were collected for HIV serology and viral load measurement. Results We identified 5162 children who were eligible for the study. Blood was obtained for 3681 (71.3%) children. Among child participants, 16.4% had been tested for HIV infection in the past, and among children with parents or guardians who self-reported HIV-positive status, 52.9% had been tested for HIV infection. Twenty-eight (0.9%) children tested HIV-positive in the survey. Of these, 11 had been previously diagnosed with HIV infection before the survey. All 11 children were in HIV care and receiving cotrimoxazole; 8 were on antiretorivral therapy (ART). Among those on ART, 4 were virologically suppressed. Conclusions HIV causes a substantial burden of disease in the Kenyan pediatric population. Although most children who had been diagnosed with HIV before the survey were engaged in care and treatment, they represented less than half of HIV-infected children identified in the survey. Future efforts should focus on identifying infected children and getting them into care and on suppressive ART as early as possible.

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Disease profile of children under 5 years attending primary health care clinics in a high HIV prevalence setting in South Africa

Cited by 18 publications

References 27 publications

The Acceptability and Feasibility of Routine Pediatric HIV Testing in an Outpatient Clinic in Durban, South Africa

The Acceptability and Feasibility of Routine Pediatric HIV Testing in an Outpatient Clinic in Durban, South Africa

Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South Africa

Burden of HIV Infection Among Children Aged 18 Months to 14 Years in Kenya

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