Abstract
Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18–29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis.
Highlights
Routine HIV-1 screening of adults in healthcare settings provides an effective strategy to identify and potentially present into care large numbers of previously undiagnosed HIV-1-positive individuals.[1,2] The importance of such screening is heightened in the current era of widespread antiretroviral therapy (ART) availability
acute HIV-1 infection (AHI) has been found to be as common as confirmed malaria in young adults seeking care for fever in coastal Kenya,[24] highlighting the need to consider this entity in areas of high HIV-1 transmission
Fever is a common complaint in adults with a wide range of potential causes, only four studies tested for aetiologies other than prevalent HIV-1 or malaria
Summary
Routine HIV-1 screening of adults in healthcare settings provides an effective strategy to identify and potentially present into care large numbers of previously undiagnosed HIV-1-positive individuals.[1,2] The importance of such screening is heightened in the current era of widespread antiretroviral therapy (ART) availability. To ensure that screening is carried out, the Joint United Nations Programme on HIV-1/AIDS issued guidance in 2007 on provider initiated testing and counselling (PITC).[3] Since PITC has been recommended as a routine part of medical care in areas with generalised HIV-1 epidemics. Kenya’s National AIDS and STI Control Programme adopted PITC in 2008, and issued National Guidelines for HIV-1 counselling and testing at government health facilities.[4]. In 2013, the 2012 Kenya AIDS indicator survey reported a steady increase in HIV-1 prevalence with age, from 2.1% among men and women aged 15–24 years to 6.4% among those aged
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