Universal HIV testing suggested for children from poorer countries
HIV testing in children from low-income and middle-income countries yielded the best opportunity to diagnose the disease and provide them with ART initiation outside of mother-to-child transmission programs, according to published study findings.
“Improvements in programs are essential to identify children living with HIV and to link them to care and ART initiation,” Jennifer Cohn, MD, MPH, clinical assistant professor of medicine at Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “Improved pediatric HIV case finding will also be necessary to meet the UNAIDS 90-90-90 goals. Existing WHO guidance recommends that, in generalized epidemics, provider-initiated testing and counseling should be offered to all adults, adolescents and children who present to health facilities.”
To provide more evidence about provider-initiated testing and counseling for children in disadvantaged countries, outside of programs that target the prevention-of-mother-to-child transmission of HIV, the researchers conducted a systematic and meta-analysis. They examined research published from January 2004 to April 2016 in PubMed, MEDLINE, WHO Global Index Medicus, Web of Science, Médecins Sans Frontières, Cochrane, Embase and other databases. Studies that indicated quantitative prevalence of HIV that was distinguished through inpatient and outpatient settings, nutrition centers and expanded programs on immunization centers were included in the analysis.
Of 2,996 studies located in the databases, 26 met the researchers’ assessment criterion. Across all settings, HIV prevalence was 15.6% (95% CI, 11.8-19.5). HIV prevalence correlated most strongly with the pediatric inpatient settings (21.1%; 95% CI, 14.9-27.3) and correlated least strongly with outpatient settings (2.7%; 95% CI, 0.3-5.2).
Cohn and colleagues wrote that the preferred approach may be universal HIV testing for children in countries where prevention-of-mother-to-child transmission is not an intervention method, since analysis data suggested that a universal approach (20.9%; 95% CI, 13.5-28.3) yielded similar diagnoses vs. inpatient settings (21.3%; 95% CI, 11.6-31).
“The studies included in this systematic review suggest that, within the four contexts assessed, use of pediatric HIV testing in inpatient and nutrition centers would give the highest yield of HIV-positive individuals,” the researchers wrote. “Furthermore, when examining the most commonly assessed context, pediatric inpatient facilities, both triggered and universal testing, yielded high pediatric HIV prevalence.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.