Paediatric HIV in central Sudan: High sero-prevalence and poor performance of clinical case definitions

Abstract

Background Paediatric clinical case definitions (CCDs) for the human immunodeficiency virus (HIV) have been proposed as screening tools in resource-limited countries. Objectives We assessed the performance of the World Health Organisation CCD (WHO-CCD), the Bloemfontein CCD (B-CCD) and a locally modified version of the Bloemfontein CCD (MB-CCD) in comparison with HIV serology in acutely hospitalised children aged 1.5–14 years. We also determined the HIV sero-prevalence among this group of children. Study design A cohort of 106 consecutive acute paediatric admissions to a major teaching hospital in central Sudan was recruited over a 3-month period. Results The WHO-CCD, B-CCD, and MB-CCD were relatively specific with estimates of 96.0% (95% confidence interval [CI] 90.1–98.9), 88.0% (95% CI 80.0–93.6), and 74.0% (95% CI 64.3–82.3), respectively. However, corresponding sensitivities were poor with estimates of 16.7% (95% CI 0.4–64.1), 33.3% (95% CI 4.3–77.7), and 66.7% (95% CI 22.3–95.7), respectively. The HIV sero-prevalence was high at 5.7% (95% CI 2.1–11.9). Conclusions CCDs performed poorly against HIV serology in acutely hospitalised children aged 1.5–14 years in central Sudan and, therefore, we advocate improving access to serological diagnostic tools. The high HIV sero-prevalence rate among this group of children poses serious challenges to policy makers and warrants further research.