HIV testing coverage of family members of adult antiretroviral therapy patients in Malawi

Cohen, Danielle B.; Lungu, M; Oosterhout, Joep J. van

doi:10.1080/09540121003720986

Cited by 14 publications

(17 citation statements)

References 12 publications

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“…In our study sibling testing had not been done in 68% of families, similar to a Malawian report showing >80% of children of adult ART patients not tested for HIV, clearly indicating need for a more family-centred approach (Cohen, Lungu & van Oosterhout, 2010;Koo, Makin & Forsyth, 2013). As many as one-third of HIV-infected children have slow disease progression and survive to adolescence without treatment (Ferrand et al, 2007;Ferrand et al, 2009).…”

Section: Discussionsupporting

confidence: 52%

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

et al. 2015

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Post-print version. Full reference: Feucht UD, Meyer A, Thomas WN, Forsyth BWC, Kruger M. Early diagnosis is critical to ensure good outcomes in HIV-infected children -Outlining barriers to care. Published: AIDS Care. 2015. doi: 10.1080/09540121.2015.1066748 Abstract HIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation.Baseline data was reviewed of all children aged <15 years referred over a one-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one quarter (24.5%) were of school-going age, 34.5% in the preschool group, 18% between 6-12 months old and 23% below six months of age (median age=1.5 years [IQR 0.5-4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%).A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (≥89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the 2 nd & 3 rd pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-toHealth Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART-services despite referral.In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not attending paediatric ART services need further exploration.

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Section: Discussionsupporting

confidence: 52%

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

et al. 2015

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“…A survey conducted in Malawi reported greater than 80% of children of adult patients on ART had not been tested for HIV [81]. Targeted family testing of all family members of known HIV-infected adults can provide early case finding for HIV-exposed and HIV-infected children [81]. This may be extended to include family testing for adults presenting with TB or sexually transmitted infections in settings in which coinfection rates are high.…”

Section: Promising Strategies For Pediatric Case Findingmentioning

confidence: 99%

Beyond early infant diagnosis

Ahmed¹,

Kim²,

Sugandhi

et al. 2013

Aids

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There are 3.4 million children infected with HIV worldwide, with up to 2.6 million eligible for treatment under current guidelines. However, roughly 70% of infected children are not receiving live-saving HIV care and treatment. Strengthening case finding through improved diagnosis strategies, and actively linking identified HIV-infected children to care and treatment is essential to ensuring that these children benefit from the care and treatment available to them. Without attention or advocacy, the majority of these children will remain undiagnosed and die from complications of HIV. In this article, we summarize the challenges of identifying HIV-infected infants and children, review currently available evidence and guidance, describe promising new strategies for case finding, and make recommendations for future research and interventions to improve identification of HIV-infected infants and children.

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“…In one study, 30% of caregivers reported that children were LTFU because caregivers either had not disclosed their own HIV status or were afraid of family/community stigma related to their HIV status or that of the child [29]. Additionally, caregivers may be unaware that pediatric HIV treatment is available and thus perceive no benefit in seeking these services for children [30]. …”

Section: Retention Of Children On Care and Treatmentmentioning

confidence: 99%

Linkage, initiation and retention of children in the antiretroviral therapy cascade

Phelps

Ahmed

Amzel

et al. 2013

Aids

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In 2012, there were an estimated 2 million children in need of antiretroviral therapy (ART) in the world, but ART is still reaching fewer than 3 in 10 children in need of treatment. [1, 7] As more HIV-infected children are identied early and universal treatment is initiated in children under 5 regardless of CD4, the success of pediatric HIV programs will depend on our ability to link children into care and treatment programs, and retain them in those services over time. In this review, we summarize key individual, institutional, and systems barriers to diagnosing children with HIV, linking them to care and treatment, and reducing loss to follow-up (LTFU). We also explore how linkage and retention can be optimally measured so as to maximize the impact of available pediatric HIV care and treatment services.

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HIV testing coverage of family members of adult antiretroviral therapy patients in Malawi

Cited by 14 publications

References 12 publications

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

Beyond early infant diagnosis

Linkage, initiation and retention of children in the antiretroviral therapy cascade

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