Abstract
BackgroundProvider Initiated Testing and Counseling (PITC) among hospitalized children have shown to increase the probability of identifying HIV-infected children and hence be able to link them to HIV care. We aimed at determining the prevalence, clinical characteristics and outcome of HIV-infected children admitted at Bugando Medical Centre (BMC) after active provision of PITC services.MethodsA cross-sectional study with follow up at three months post enrollment was done. Children with unknown HIV status were tested for HIV infection as per 2012 Tanzanian algorithm. Questionnaires were used to collect demographic, clinical and follow up information. Data was statistically analyzed in STATA v13.ResultsA total of 525 children were enrolled in the study. Median [IQR] age was 28 [15–54] months. Males consisted of 60.2% of all the participants. HIV prevalence was 9.3% (49/525). Thirty-three (67.3%) of HIV-infected children were newly diagnosed at enrolment. Thirty-nine (79.6%) of all HIV-infected patients had WHO HIV/AIDS clinical stage four disease, 10 (20.4%) had WHO clinical stage three and none qualified in stage one or two. About 84% (41/49) of HIV infected children had severe immunodeficiency at the time of the study. Factors that were independently associated with HIV infection were, cough (OR 2.40 [1.08–5.31], p = 0.031), oral thrush (OR 20.06[8.29–48.52], p < 0.001), generalized lymphadenopathy (OR 5.61 [1.06–29.56], p = 0.042), severe acute malnutrition (OR 6.78 [2.28–20.12], p = 0.001), severe stunting (OR 9.09[2.80–29.53], p = 0.034) and death of one or both parents (OR 3.62 [1.10–11.87], p = 0.034). The overall mortality (in-hospital and post-hospital) was 38.8% among HIV-infected children compared with 14.0% in HIV-uninfected children. Within three months period after discharge from the hospital, 71.4% (25/35) of discharged HIV-infected children reported to have attended HIV clinic at least once and 60.0% (21/35) were on antiretroviral medications.ConclusionPITC to all admitted children identified significant number of HIV-infected children. Mortality among HIV-infected children is high compared to HIV-uninfected. At the time of follow up about 30% of discharged HIV-infected children did not attend to any HIV care and treatment clinics. Therefore effective efforts are needed to guarantee early diagnosis and linkage to HIV care so as to reduce morbidity and mortality among these children.
Highlights
Provider Initiated Testing and Counseling (PITC) among hospitalized children have shown to increase the probability of identifying Human Immunodeficiency Virus (HIV)-infected children and be able to link them to HIV care
HIV-infected children are at a higher risk of being hospitalized due to common childhood illnesses like pneumonia and malnutrition with associated high mortality compared to their uninfected counterparts, and majority of the deaths occurring before their second birthday if not initiated on antiretroviral therapy [8, 9]
A study done among adults in the Lake zone of Tanzania, reported a 59.3% of late diagnosis of HIV infection with 78.7% of them being in stage 3 and 4 of the disease who were likely to be diagnosed following PITC services [10].Linkage to care is essential to HIV-infected individuals, because it ensures that they benefit from the referral and appropriate follow up services available at HIV care and treatment centres
Summary
Provider Initiated Testing and Counseling (PITC) among hospitalized children have shown to increase the probability of identifying HIV-infected children and be able to link them to HIV care. A study done among adults in the Lake zone of Tanzania, reported a 59.3% of late diagnosis of HIV infection with 78.7% of them being in stage 3 and 4 of the disease who were likely to be diagnosed following PITC services [10].Linkage to care is essential to HIV-infected individuals, because it ensures that they benefit from the referral and appropriate follow up services available at HIV care and treatment centres. Examples of such services include receiving prophylactic co-trimoxazole therapy and/ or ART, screening, prevention and management HIV related co-infections and co-morbidities. By the end of the year 2012 in Mwanza region-Tanzania, the cumulative number of children who were enrolled into HIV care and treatment was 8104 and of these, 4348 (53.6%) were receiving Antiretroviral therapy and a total of 115,620 adults were enrolled into HIV care and of these, 66,425 (57.5%) were on Antiretroviral therapy [11]
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
