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Universal HIV testing recommended for children from low-income countries
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HIV testing in children from low- and middle-income countries yielded the best opportunity to diagnose the disease and initiate ART outside of mother-to-child transmission programs, according to findings from a systematic review and meta-analysis.
“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 the the University of Pennsylvania’s Perelman School of Medicine, 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 examine the case-finding benefit of HIV screening in children aged 0 to 5 years in disadvantaged countries, Cohn and colleagues conducted a systematic review and meta-analysis that included research published from January 2004 to April 2016. Studies that reported the quantitative prevalence of HIV in four “key” contexts — 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 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 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
- Reference:
- Cohn J, et al. Lancet HIV. 2016;doi:10.1016/S2352-3018(16)30050-9.
Disclosure: The researchers report no relevant financial disclosures.