Abstract
Background and design. HIV is a major contributor to childhood morbidity and mortality in South Africa. We describe HIV prevalence, disease profile, outcome and missed opportunities for early intervention in a cohort of HIV-infected children admitted to Chris Hani Baragwanath Hospital’s general paediatric wards between 1 October and 31 December 2007. 
 
 Results. Of 1 510 admissions, 446 (29.5%) were HIV-infected. Many children (238, 54.1%) were newly diagnosed in hospital and most had advanced HIV disease (405, 92%). The principal admission diagnoses were pneumonia (165, 37.5%), gastro-enteritis (97, 22%), sepsis (86, 19.5%) and tuberculosis (92, 21%). Of children identified as HIV infected before admission, 128/202 (63.4%) were not accessing antiretroviral treatment (ART), although 121/128 (94.5%) met ART eligibility criteria. Of 364 ART-naïve eligible children, only 15 (4.1%) were commenced on ART as inpatients. Problems with PMTCT implementation in infants under 6 months (N=166) included lack of maternal antenatal HIV testing (51, 30.7%); poor uptake of maternal/infant nevirapine prophylaxis (60, 36.2%); limited use of co-trimoxazole (CTX) prophylaxis (44/147, 29.9%); and delayed infant HIV polymerase chain reaction testing (98/147, 87.5%). Of infants known to be HIV infected prior to hospitalisation, 37/51 (73%) had not initiated ART. The in-hospital case fatality rate (CFR) among HIV-infected children was triple that of the combined HIV-uninfected, exposed and unknown group (12% v. 3.6%). Infants
Highlights
Background and designHIV is a major contributor to childhood morbidity and mortality in South Africa
Hospitalised antiretroviral therapy (ART)-eligible children should be prioritised for inpatient initiation of ART
South Africa has 5.6 million people living with HIV, including approximately 280 000 children[1] who suffer disproportionate morbidity and double the mortality of their HIV-uninfected counterparts.[2,3]
Summary
The study was approved by University of the Witwatersrand Human Research Ethics Committee (reference No M080202). The study was undertaken at CHBH, Soweto, Johannesburg, in the Gauteng province of South Africa. This 2 964-bed referral hospital is the only public hospital serving approximately 3.5 million Sowetans and accepts referrals from local primary health care clinics, regional hospitals in Gauteng and neighbouring provinces of South Africa. The province’s health sector, challenged by high TB and HIV prevalence, is relatively well resourced and staffed when compared with other areas of South Africa. A dedicated paediatric HIV clinic on the hospital premises (Harriet Shezi clinic) provides outpatient services to more than 3 500 HIV-infected children and the Perinatal HIV Research Unit (PHRU) provides PMTCT support in the Soweto area
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
