Abstract
BackgroundIndia lacks epidemiological information on the disease burden of pediatric HIV. The National AIDS Control Program (NACP) estimates the numbers of HIV-positive children as a proportion of adult persons living with HIV. A third of HIV-positive children die before their first birthday and a half before they reach their second birthday. The early detection of HIV is crucial for the prevention of morbidities, growth delays, and death among HIV-positive children.MethodsThe study aimed to estimate the disease burden of pediatric HIV among children in ‘A’ category district of a high HIV prevalence state. An ‘A’ category district is defined by the presence of > 1% HIV prevalence among the general population, as estimated by HIV Sentinel Surveillance. The study used an innovative three-pronged strategy combining cross-sectional and longitudinal methods. The overall burden of pediatric HIV was calculated as a product of cases detected multiplied by a net inflation factor, for each of three strategies.ResultsThe existing pool of HIV infection in the district is estimated to be 3266 (95% CI: 2621–4197) HIV positive children < 15 years of age, in a mid-year (2013) projected child population of about 1.4 million, thus giving an HIV prevalence of 0.23% (CI: 0.19–0.30) among children (0–14 years of age). The proportion of children among all people living with HIV in the district works out to 10.4% (CI: 8.6–13.5%).ConclusionsThe study estimate of 0.23% HIV prevalence among children (0–14 years of age) is higher than the NACP estimates (0.02) and is 2.5 higher than the Karnataka state estimate (0.09)22. Similarly, the proportion of children among all persons living with HIV in Belgaum district is 10.4% in this study, as against 6.54% for India. The study methodology is replicable for other settings and other diseases.
Highlights
The number of persons living with Human immunodeficiency virus (HIV) is on the rise and is projected to be an emerging threat to public health
Cross-sectional analyses were used to estimate HIV prevalence among children (0–14 years) living within families with an index person living with HIV and among children attending outpatient departments from a stratified random sample of public and private health care facilities in the district
In Strategy II, using age-appropriate testing as described above, we examined HIV prevalence among children (0– 14 years) residing in a family with an index person living with HIV
Summary
The number of persons living with HIV is on the rise and is projected to be an emerging threat to public health. The National AIDS Control Program (NACP) provides estimates of pediatric HIV that are based on its proportion to adult infections. The WHO recommended various methods to estimate pediatric HIV including case reporting, household surveys, immunization clinic surveys, in-school and out-of-school surveys, mortality data, and vital registration [6]. These methods have been used in countries with a high HIV prevalence: South Africa, Nigeria, Kenya, Thailand, Argentina, Mozambique, Malawi, Indonesia, and others [7,8,9]. The National AIDS Control Program (NACP) estimates the numbers of HIV-positive children as a proportion of adult persons living with HIV. The early detection of HIV is crucial for the prevention of morbidities, growth delays, and death among HIV-positive children
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