High HIV testing yield found in children attending or accompanying those attending TB, malnutrition and HIV clinics in Uganda, 2017
Background: Optimizing identification of undiagnosed HIV among
children is critical in reducing the global burden of pediatric HIV/AIDS. Understanding
the HIV testing yield among children at different facility-based entry points can
inform more efficient pediatric HIV testing strategies. We assessed entry point
HIV testing yield among children 18 months to 15 years in 4 regions of Uganda.
Methods: HIV testing was offered to 3245 children at 8 health facilities (4
regional referral and 4 district hospitals) from February 2017 to June 2017. All
children who entered through outpatient department (OPD), inpatient department
(IPD), malnutrition, TB and special (HIV, sickle cell, young child clinic(YCC), and
eye clinics, whether patients themselves or accompanying patients, were
reviewed for HIV status and offered a test if their status was unknown. A retest
for verification was provided for every child that tested HIV positive. HIV testing yield was defined as the
proportion of HIV positive children among those tested. Proportions,
percentages, chi-square and fisher exact tests were used in the analysis of
results.
Results: Uptake for HIV
testing was 96% (3119/3245) with an overall yield of 1.4% (45/3119). Among entry
points; TB, nutrition and special clinics had the highest HIV testing yield at 5.6% (4/71),
2.2% (2/92) and 2.4% (17/706) respectively (p=0.001). Among special clinics, HIV
clinic had the highest yield at 52.9% (9/17). In spite of their low HIV testing
yield, OPD 1.1% (12/1126) and IPD 1.0% (10/1046) accounted for the highest
number of children testing HIV positive. YCC clinic had low testing volumes and
no yield.
Conclusions: TB, nutrition and
HIV clinic entry points had the highest HIV test yield while, OPD and IPD
accounted for the largest number of HIV positive children identified. This
finding further emphasizes the need for HIV testing for all children with TB,
malnutrition, and those who have family members living with HIV. In OPD and IPD
settings, however, introduction of a screening tool could maximize HIV testing
yield while more efficiently utilizing limited testing resources.
[Figure 1: HIV positive yield at the various HTS entry points]
H. Bitimwine1, G.P. Kisitu2, R. N. Ssebunya2, D. Damba2, P. Nahirya Ntege2, B. Asire3, J.K. Kabanda4, E. Nazziwa4, J. Kalamya4, M. Adler4, A. Kekitiinwa2
1Ministry of Health, AIDS Control Program, Kampala, Uganda, 2Baylor College of Medicine Children's Foundation, Kampala, Uganda, 3UNICEF, Kampala, Uganda, 4Centers for Disease control and Prevention, Entebbe, Uganda