Delayed HIV Diagnosis Research Articles

Tuberculosis and HIV-An Update on the "Cursed Duet" in Children.

HIV and tuberculosis (TB) often occur together with each exacerbating the other. Improvements in vertical transmission prevention has reduced the number of HIV-infected children being born and early antiretroviral therapy (ART) protects against tuberculosis. However, with delayed HIV diagnosis, HIV-infected infants often present with tuberculosis co-infection. The number of HIV exposed uninfected children has increased and these infants have high exposure to TB and may be more immunologically vulnerable due to HIV exposure in utero. Bacillus Calmette-Guérin (BCG) immunization shortly after birth is essential for preventing severe TB in infancy. With early infant HIV diagnosis and ART, disseminated BCG is no longer an issue. TB prevention therapy should be implemented for contacts of a source case and for all HIV-infected individuals over a year of age. Although infection can be identified through skin tests or interferon gamma release assays, the non-availability of these tests should not preclude prevention therapy, once active TB has been excluded. Therapeutic options have moved from isoniazid only for 6–9 months to shorter regimens. Prevention therapy after exposure to a source case with resistant TB should also be implemented, but should not prevent pivotal prevention trials already under way. A microbiological diagnosis for TB remains the gold standard because of increasing drug resistance. Antiretroviral therapy for rifampicin co-treatment requires adaptation for those on lopinavir-ritonavir, which requires super-boosting with additional ritonavir. For those with drug resistant TB, the main problems are identification and overlapping toxicity between antiretroviral and anti-TB therapy. In spite of renewed focus and improved interventions, infants are still vulnerable to TB.

Earlier diagnoses and faster treatment of HIV in the District of Columbia: HIV surveillance analysis, 2006–2016

ABSTRACTTo address high HIV prevalence, the District of Columbia (DC) Department of Health has implemented multiple strategies to increase routine HIV testing since 2006. Examination of delayed HIV diagnosis over time can demonstrate population-level impact of public health strategies to promote HIV testing. Using HIV surveillance data, we examined delayed HIV diagnosis in DC (stage 3 within 90 days of diagnosis), CD4 count at HIV diagnosis, linkage to HIV care, and time to viral suppression among DC residents age 13 and above who were diagnosed from 2006 to 2016. We used the Cochran-Armitage test of trend, Cuzick’s test of trend, and Chi-square for univariate analyses, and we examined factors associated with delayed HIV diagnosis using a log-binomial multivariate model. 7,937 DC residents were diagnosed with HIV and had available data. Between 2006 and 2016, delayed HIV diagnoses declined from 36.4% to 25.5%, median CD4 count increased from 190 cells/µl to 426 cells/µl, and median time from HIV diagnosis to viral suppression declined from 1,136 days to 84 days. Women, youth ages 13-29, and men who have sex with men had lower proportions with delayed HIV diagnosis. In the multivariate models, racial/ethnic disparities in delayed HIV diagnoses were apparent during 2006-2008 but not during 2009-2016. Continued efforts around earlier HIV testing are needed in DC.

EVALUATION OF CLINICAL CONDITION, IMMUNOSUPRESSION AND VIRAL ACTIVITY IN PATIENTS WITH HIV INFECTION

Materials and methods. The course and the main clinical and laboratory parameters of HIV infection course were studied in 300 HIV patients featuring different clinical symptoms, general conditions and outcomes of their disease. The patients were followed up at Saint-PetersburgCenterfor Prevention and Control of AIDS and Infectious Diseases (AIDSCenter). A modified Karnofsky scale was used to assess the general physical conditions of the patients. The scale defines patient’s condition in 10% steps from 100% (normal conditions) to 0% (death). The patients were examined upon admission and in 6 and 12 months thereafter. They were assigned to two groups, 150 subjects each. Group 1 comprised patients who were hospitalized at advanced stages of HIV infection because of delayed diagnosis when HIV was already manifested clinically, the severity of patients’ conditions was determined by opportunistic or concomitant somatic and neurologic conditions determined, and CD4 cell counts were below 199 ml–1. This group also included patients who did not receive ART because of different reasons, including delayed HIV diagnosis, refusal to be treated, social and domestic circumstances etc., or either were treated irregularly, i.e., in prolonged non-treatment intervals or discontinued treatment. In this group, 28 patients discontinued ART, and the rest never received ART. Group 2 comprised HIV patients whose conditions were well preserved and CD4 cell counts were 200-350 ml–1. The patients were hospitalized for control examinations or for correction of therapy and had no severe clinical symptoms. The study did not involve active drug abusers and patients with endogenous mental disorders. ART was prescribed or renewed under in-hospital conditions according to indications, and the most adequate ART regimens were chosen. Measures to develop adherence to therapy were taken. Statistical treatment was carried out using Vortex ver. 6 and MS Excel 2010 software. Results: Significant negative correlations were found in both groups between the index of patients’ physical wellbeing, which was assessed using the modified Karnofsky Scale, and CD4 cell counts, HIV RNA levels, and the presence of severe opportunistic infections. Negative changes in the index were associated not only with the worsening of patient conditions but also with the need for repeated hospitalizations and prolonged rehabilitation and with unfavorable outcomes. When immunity was improved with ART, Karnofsky index changed positively in both groups, more so in the Group 2. Conclusion: Karnofsky index may be employed as a simple and easily available clinical approach useful in any medical discipline for assessing the general conditions of patients, in particular, for planning individual therapeutic regimens for HIV patients treated under outpatient and inpatient conditions.

Delayed Diagnosis of HIV among Non-Latino Black Caribbean Immigrants in Florida 2000-2014.

Prompt HIV diagnosis decreases the risk of HIV transmission and improves health outcomes. The study objective was to examine rates of delayed HIV diagnosis among non-Latino Black Caribbean immigrants in Florida. The sample included 39,008 Black HIV-positive individuals, aged 13 or older from the Caribbean and the mainland U.S. Delayed HIV diagnosis was defined as AIDS diagnosis within three months of HIV diagnosis. After adjusting for demographic factors, year of HIV diagnosis, transmission mode, neighborhood level socioeconomic status, and rural-urban residence, a disparity persisted for Caribbean-born Blacks in the Bahamas and Haiti compared with U.S.-born Blacks. Male Jamaican-Bahamian-Haitian-born Blacks were more likely to have delayed diagnosis (aOR 2.17, 95% confidence interval [CI] 1.53-3.03; aOR 1.88, 95% CI 1.01-3.44; aOR 1.58, 95%CI 1.58). Findings suggest the need for targeted, culturally relevant interventions to reduce delayed diagnosis incidence among specific Caribbean-born Blacks.

Prevalence and associated factors of late HIV diagnosis in north-western rural Tanzania: a cross sectional study

Background: Despite scaling up of HIV and treatment services to improve the outcome of people living with HIV, still a high proportion of patients seek out medical attention at late stages of the disease. This contributes to late initiation of ART and poor clinical outcome especially in sub Saharan Africa. The literature on magnitude of this problem in Tanzania is still scarce. This study aimed to determine the prevalence and associated factors of delayed HIV diagnosis in rural Tanzania.Methods: This was a cross sectional study, involving newly diagnosed adult HIV patients sent in for care and treatment linkage. Information regarding age, sex, WHO stage, type of opportunistic condition, HIV testing service and on diagnosis CD4 counts were all collected. On diagnosis CD4 counts <200cells/µl was coded as Late HIV diagnosis. The proportion of with Late HIV diagnosis was calculated and logistic regression modal was used to determine the degree of association of different variables at 95%CI.Results: In total 649 patients were included in this study. The median age of the study participants was 45.5 years most of them being females 396 (61.02%). The median CD4 count was 168 cells/µl and majority of our study participants 468 (72.11%) were in WHO clinical stage 3&4. Overall 385 (59.32%) were found to have Late HIV diagnosis where 303 (78.70%) had stage 3&4 AIDS defining illness (OR=2.2, p<0.001). Male patients were predominantly affected (OR=1.4, p=0.035), who were more likely to be tested following PITC service (OR=30, p<0.001).Conclusions: Late HIV diagnosis is prevalent in our setting with high prevalence of most of the stage 3&4 AIDS defining illnesses. Male patients are predominantly affected as late presenters. There is a need to strengthen and extend the available Provider Initiated Testing and Counselling activities to primary health care level.

Diagnosis and monitoring of HIV programmes to support treatment initiation and follow up and improve programme quality.

The HIV 'cascade of care' breaks down at several points, with delayed HIV diagnosis, late treatment initiation, or interruption, leading to new morbidity and mortality and loss of prevention effects. New approaches are needed at each step. HIV testing is still not reaching certain communities, resulting in late presentation. Creative ways to reach these communities is being explored, including with self-testing. HIV misdiagnosis is increasingly recognized as undermining testing programmes, highlighting the need for better quality control. More rapid antiretroviral initiation, even on the same day, initiation outside of health facilities, and more efficient defaulter re-initiation, may mean better retention and virological control. New antiretrovirals may address side effects responsible for poor adherence and treatment failure, as well as requiring lower adherence levels. Viral load monitoring expansion is required, but mechanisms are needed to ensure healthcare workers act on detectable results; point of care technologies may partly address this. Side-effect monitoring at a programme level is needed to characterise 'real world' effectiveness. Integrated monitoring systems, using single patient identifiers and utilizing national laboratory data systems, will allow for better characterization and interventions that limit loss to follow up, and allow better pharmacovigilance and programme performance.

¡Sólo Se Vive Una Vez! (You Only Live Once): A Pilot Evaluation of Individually Tailored Video Modules Aiming to Increase HIV Testing Among Foreign-Born Latino Men.

Although Latinos living in the United States are disproportionately affected by HIV, the development, implementation, and evaluation of HIV prevention, testing, and linkage to care interventions lag behind efforts occurring in other communities. To address sociocultural barriers to testing, we developed a multilevel intervention. This study is a pilot evaluation of the individual-level component of the intervention-animated video modules that address specific barriers to HIV testing common among foreign-born Latino men. We conducted a survey assessing HIV risk and barriers to testing with a convenience sample of 104 foreign-born Latino men in Baltimore, MD, who had not tested for HIV within the past year. Intention to test in the next 3 months was measured before and after viewing an intervention module selected based on survey responses. Fifty-two (50.0%) participants had never tested for HIV. Of the participants who had previously tested for HIV, the mean time since their last test was 3.48 years (SD = 3.55). Participants' intention to test for HIV significantly increased after watching the module (t = -8.28, P < 0.001). Increased intention to test was not associated with any socio-demographic characteristics (ie, age, country of origin) or reported sexual behaviors (ie, number of sex partners in the past year). These results suggest that our culturally sensitive, individually tailored intervention can be an additional tool to encourage HIV testing among previously untested foreign-born Latino men, one of the demographic groups at highest risk for delayed HIV diagnosis in the United States.

Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe

Socioeconomic inequality challenges population-level implementation of health interventions. We investigated differences by educational level in clinical, virological, and immunological responses to combined antiretroviral treatment (cART) in HIV-positive men and women in Collaboration of Observational HIV Epidemiological Research in Europe, a European collaboration. Data were pooled from 15 cohorts in eight countries of patients initiating cART in 1996-2013 with data on educational level categorized in UNESCO/ISCED classifications. Kaplan-Meier curves, Cox and piecewise linear mixed models were used. Of 24 069 HIV-positive patients, 9% had not completed primary education, 32% had completed primary, 44% secondary, and 15% tertiary education. Overall, 21% were women, who were overrepresented in lower educational strata. During 132 507 person-years of follow-up, 1081 individuals died; cumulative mortality decreased with higher educational level (P < 0.001). Over 122 765 person-years, new AIDS events or death occurred in 2598 individuals; differences by education were more marked than for death alone (P < 0.001). Virological response was achieved by 67% of patients without completed basic education, 85% with completed primary education, 82% with secondary, and 87% with tertiary (P < 0.001). Patients with higher education had higher CD4 cell count at cART initiation and at each time after cART but rate of CD4 cell count recovery did not differ. Differences in mortality and clinical responses were similar for men and women and were not entirely explained by delayed HIV diagnosis and late cART initiation. HIV-positive patients with lower educational level had worse responses to cART and survival in European countries with universal healthcare. To maximize the population impact of cART, Europe needs to decrease the socioeconomic divide.

Late diagnosis and advanced disease of HIV in adult patients from a Peruvian social security hospital

The delayed HIV diagnosis with CD4 count is a public health problem. To determinate the frequency and the factors associated with a late diagnosis (LD) and to an advanced disease (AD) of HIV infection in patients from a Peruvian hospital. Analytic and transversal study of secondary data from adult's patients diagnostic with HIV during the period 1999-2012. From 1,714 patients, 82.6% (1416) had LD, and 64.5% (1106) were diagnostic with AD. Were associated with them: being of male sex (LD: 17% and AD: 28%; p < 0.001), have between 41-60 years (LD: 9% and AD: 15%; p < 0.001), have more than 60 years old (LD: 14% and AD: 23%; p < 0.003), being bisexual (LD: 18% and AD: 43%; p < 0.001), drugs abusers (LD: 24% and AD: 64%; p < 0.001). Being heterosexual was associated with less frequency (LD: 12% and AD: 19%; p < 0.001). The frequency of LD and AD of HIV are high and factors associated with them were male sex, being 40 years old or more, and belonging to sexually risk groups (homosexuals and bisexuals) and drugs abusers.

Mortality risk in older people on antiretroviral therapy

The report by Morna Cornell and colleagues1 in The Lancet HIV on the effect of age on mortality in a large South African antiretroviral treatment (ART) programme emphasises three issues for health-care delivery: ageing of the population of people with HIV who are receiving therapy, possibly poor immunological response to ART in older people, and delayed HIV diagnosis and treatment initiation in older people

Temporal increase in HIV-1 non-R5 tropism frequency among antiretroviral-naive patients from northern Poland.

IntroductionSequencing of the third hypervariable loop allows to identify genotype-based HIV tropism. R5-tropic viruses associated with early stages of infection are preferentially transmitted, while non-R5 HIV-1 tropism has been associated with severe immunodeficiency and lower lymphocyte CD4 nadir and may reflect delayed HIV diagnosis. In this study, we investigate the changes in tropism frequency from 2007 to 2013.Materials and MethodsStudy included 194 patients with confirmed HIV infection linked to care in 2007–2013. Baseline plasma samples from treatment naive patients were used for HIV-1 genotypic tropism assessment based on triplicate V3 loop sequencing. Non-R5 tropism prediction thresholds were assigned using a false positive rate (FPR) of 10% and 5.75% FPR and associated with clinical and laboratory data (age, gender, date of HIV diagnosis, route of transmission, CDC clinical category at diagnosis, pretreatment HIV viral load, baseline and nadir lymphocyte CD4 counts). For statistics, chi-square and Mann–Whitney U tests were used, time trends were examined using logistic regression (R statistical platform, v. 3.1.0) for binary variables and linear regression for continuous ones.ResultsOverall non-R5 tropism frequency for the 5.75% FPR was 15.5% and 27.8% for 10% FPR. Frequency of the non-R5 tropism predicted using 5.75% FPR increased significantly from 2007 (0%) to 2013 (25%) [OR: 1.44 (95% CI 1.14–1.86), p=0.003, rough slope +3.89%/year] (Figure 1a). With 10% FPR, the frequency changed from 7% (2007) to 33% (2013) [OR: 1.17 (95% CI 0.99–1.39), p=0.054, rough slope +3.0%/year] (Figure 1b). Baseline lymphocyte CD4 count and nadir, as well as pretreatment HIV-1 viral loads were stable over time of observation (r=0.014, p=0.84; r=0.13, p=0.085; r=0.016, p=0.83 for CD4 baseline, nadir and HIV load, respectively). Frequency of AIDS at HIV diagnosis increased from 21.4% in 2007 to 38.0% in 2013, however trend over time was insignificant [OR: 1.1 (95% CI 0.95–1.31), p=0.19]. Temporal trends for HIV transmission route, gender, non-B variant frequencies also were not significant.ConclusionsR5 tropism predominates among the treatment naive individuals but increase in the frequency of non-R5 tropic variants may limit clinical efficacy of the coreceptor inhibitors. Increased prevalence of non-R5 HIV-1 may be related to late care entry and higher number of AIDS diagnoses in the recent years.

Delayed HIV diagnosis common in Sweden, 2003-2010.

BackgroundEarly diagnosis of HIV is important for the prognosis of individual patients, because antiretroviral treatment can be started at the appropriate time, and for public health, because transmission can be prevented.MethodsData were collected from 767 HIV patients who were diagnosed in Sweden during 2003–2010 and were infected in Sweden or born in Sweden and infected abroad. A recent infection testing algorithm (RITA) was applied to BED-EIA test results (OD-n < 0.8), CD4 counts (≥ 200 cells/μl), and clinical information. A recent infection classification was used as indicator for early diagnosis. Time trends in early diagnosis were investigated to detect population changes in HIV testing behavior. Patients with early diagnosis were compared to patients with delayed diagnosis with respect to age, gender, transmission route, and country of infection (Sweden or abroad).ResultsEarly diagnosis was observed in 271 patients (35%). There was no statistically significant time trend in the yearly percentage of patients with early diagnosis in the entire study group (p = 0.836) or in subgroups. Early diagnosis was significantly more common in men who have sex men (MSM) (45%) than in heterosexuals (21%) and injecting drug users (27%) (p < 0.001 and p = 0.001, respectively) in both univariate and multivariable analyses. The only other factor that remained associated with early diagnosis in multivariable analysis was young age group.ConclusionApproximately one-third of the study patients were diagnosed early with no significant change over time. Delayed HIV diagnosis is a considerable problem in Sweden, which does not appear to diminish.

Delayed HIV diagnosis and initiation of antiretroviral therapy: inequalities by educational level, COHERE in EuroCoord.

In Europe and elsewhere, health inequalities among HIV-positive individuals are of concern. We investigated late HIV diagnosis and late initiation of combination antiretroviral therapy (cART) by educational level, a proxy of socioeconomic position. We used data from nine HIV cohorts within COHERE in Austria, France, Greece, Italy, Spain and Switzerland, collecting data on level of education in categories of the UNESCO/International Standard Classification of Education standard classification: non-completed basic, basic, secondary and tertiary education. We included individuals diagnosed with HIV between 1996 and 2011, aged at least 16 years, with known educational level and at least one CD4 cell count within 6 months of HIV diagnosis. We examined trends by education level in presentation with advanced HIV disease (AHD) (CD4 <200 cells/μl or AIDS within 6 months) using logistic regression, and distribution of CD4 cell count at cART initiation overall and among presenters without AHD using median regression. Among 15 414 individuals, 52, 45,37, and 31% with uncompleted basic, basic, secondary and tertiary education, respectively, presented with AHD (P trend <0.001). Compared to patients with tertiary education, adjusted odds ratios of AHD were 1.72 (95% confidence interval 1.48-2.00) for uncompleted basic, 1.39 (1.24-1.56) for basic and 1.20 (1.08-1.34) for secondary education (P < 0.001). In unadjusted and adjusted analyses, median CD4 cell count at cART initiation was lower with poorer educational level. Socioeconomic inequalities in delayed HIV diagnosis and initiation of cART are present in European countries with universal healthcare systems and individuals with lower educational level do not equally benefit from timely cART initiation.

Evaluation of pharmacy-based HIV testing in a high-risk New York City community

Injection drug users (IDUs) face limited access to HIV testing and experience delayed HIV diagnoses. New York City (NYC) pharmacies play an important role in HIV prevention among IDUs through the Expanded Syringe Access Program (ESAP), which provides access to sterile syringes without a prescription. We examined in-pharmacy HIV testing among syringe/non-syringe customers in ESAP pharmacies in NYC.

Personal and Contextual Factors Related to Delayed HIV Diagnosis Among Men Who Have Sex With Men

Delayed HIV diagnosis among men who have sex with men (MSM) in the United States continues to be a significant personal and public health issue. Using qualitative and quantitative data from 75 recently tested, HIV-sero-positive MSM (38 delayed and 37 nondelayed testers), the authors sought to further elucidate potential personal and contextual factors that may contribute to delayed HIV diagnosis among MSM. Findings indicate that MSM who experience multiple life stressors, whether personal or contextual, have an increased likelihood of delaying HIV diagnosis. Furthermore, MSM who experience multiple life stressors without the scaffolding of social support, stable mental health, and self-efficacy to engage in protective health behaviors may be particularly vulnerable to delaying diagnosis. Interventions targeting these factors as well as structural interventions targeting physiological and safety concerns are needed to help MSM handle their life stressors more effectively and seek HIV testing in a timelier manner.

Prevalence of HIV and Associated Factors among Infants Born to HIV Positive Women in Amhara Region, Ethiopia

Background: An estimated 1.2 percent of pregnant women are living with HIV in Ethiopia and sadly, one of every 3 children born to these women is infected with HIV. Elimination of these mother-to-child transmissions (MTCT) of HIV is possible through HIV testing during pregnancy and taking antiretroviral medications. However, only 24 percent of pregnant women living with HIV have yet received the medication needed to prevent MTCT of HIV in Amhara region, Ethiopia. Hence, there exists a concern that the rate of HIV infection among infants born to HIV positive mothers might be high. This study assessed the prevalence of HIV infection and associated factors among infants born to women living with HIV. Methods: All eligible records of HIV-exposed infants enrolled between January and December 2012 were reviewed from 17 health facilities which were providing PMTCT services. The study included 434 HIV-exposed infants having HIV DNA/PCR test result. Data were collected using structured data extraction formats. Data were then entered into EPI INFO Version 3.5.1 and analyzed by SPSS Version 16.0. Both bivariate and multivariate analyses were carried out to calculate odds ratios and to control for the effect of confounding. Result: The prevalence of HIV among exposed infants was 10.1%. Delay in HIV diagnosis (AOR = 1.3), mixed infant feeding (AOR = 8.8), failure to receive antiretroviral therapy during pregnancy or breast feeding (AOR = 21.6), failure to attend skilled delivery service (AOR = 6.1) and shorter duration of HIV treatment (AOR = 12) were the factors that increase the risk of mother-to-child transmission of HIV in this study. Conclusion: The prevalence of HIV among infants born to HIV positive women in the region is close to the national estimate of 10.9%. Delayed HIV diagnosis, inadequate use of antiretroviral therapy and lack of skilled delivery care were the factors that enhance mother-to-child transmission of HIV. Having such a significant figure in the era of the world’s pledge to eliminate MTCT of HIV is unbearable. Ensuring access and use of integrated PMTCT services should be the top priorities of the national PMTCT program.

Scaling Up Antiretroviral Treatment Services in Karnataka, India: Impact on CD4 Counts of HIV-Infected People

SettingTwelve antiretroviral treatment centres under National AIDS Control Programme (NACP), Karnataka State, India.ObjectiveFor the period 2004-2011, to describe the trends in the numbers of people living with HIV (PLHIV) registered for care and their median baseline CD4 counts, disaggregated by age and sex.DesignDescriptive study involving analysis of routinely captured data (year of registration, age, sex, baseline CD4 count) under NACP.Results34,882 (97% of total eligible) PLHIV were included in analysis. The number registered for care has increased by over 12 times during 2004-11; with increasing numbers among females. The median baseline CD4 cell count rose from 125 in 2004 to 235 in 2011 – the increase was greater among females as compared to males. However, about two-thirds still presented at CD4 cell counts less than 350.ConclusionWe found an increasing trend of median CD4 counts among PLHIV presenting to ART centres in Karnataka, an indicator of enhanced and early access to HIV care. Equal proportion of females and higher baseline CD4 counts among them allays any fear of differential access by gender. Despite this relative success, a substantial proportion still presented at low CD4 cell counts indicating possibly delayed HIV diagnosis and delayed linkage to HIV care. Universal HIV testing at health care facilities and strengthening early access to care are required to bridge the gap.

Using Mobile Health Technology to Improve HIV Care for Persons Living with HIV and Substance Abuse

Using Mobile Health Technology to Improve HIV Care for Persons Living with HIV and Substance Abuse

Assessment of Five Years’Comprehensive Management of HIV-Infected Children in Parakou

Introduction: The Pediatric Unit of the Borgou Regional Hospital (CHD-Borgou) in Parakou has initiated treating HIV-infected children with Anti-Retroviral (ARV) drugs since 2005. This study aimed to describe the profile and the future of the HIV-infected children who were provided medical care at the Pediatric Unit of the CHD-Borgou from 2005 to 2009. Patients and methods: It is a retrospective study with descriptive and analytical objective, carried out from January 2005 to December 2009 on 105 HIV-infected children from both sexes cared in that Unit. Results: HIV infection represented 0.43% of the children brought for medical examination during the study period. Among these children, 82.9% were at clinical stages 3 or 4 on inclusion into patient panel and 76.2% had severe immunodeficiciency. The proportion of children on Anti-Retroviral Therapy (ART) was 69.1%. The main opportunistic infections found were digestive (30.3%), pulmonary (28.5%), dermatological (24.1%) and ENT (10.5%) ones. The problems identified included lack of early diagnostic tools, frequent shortage of antiretroviral drugs, treatment or therapeutic failures, causes related to poor compliance and follow up. The lost of follow up rate was 39%. Death rate was 33.3%. Death was significantly associated with the advanced clinical stage of disease on admission (p=0.002), with age at the time of screening (p=0.017) and with follow up duration (p=0.000). Conclusion: Despite the difficulties noted, this study showed that, in limited resources settings like ours, it is possible to improve the clinical outcome of HIV infected children. The high mortality rate noted related to the delayed HIV diagnosis can be reduced by strengthening the Prevention of Mother to Child Transmission (PMTCT) program.

HIV testing and counselling for migrant populations living in high-income countries: a systematic review

Background: The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries. Methods: Systematic literature review of the five main databases of articles in English from Europe, North America and Australia between 2005 and 2009. Results: Of 1034 abstracts, 37 articles were selected. Migrants, mainly from HIV-endemic countries, are at risk of HIV infection and its consequences. The HIV prevalence among migrants is higher than the general population’s, and migrants have higher frequency of delayed HIV diagnosis. For migrants from countries with low HIV prevalence and for ethnic minorities, socio-economic vulnerability puts them at risk of acquiring HIV. Migrants have specific legal and administrative impediments to accessing HIV testing—in some countries, undocumented migrants are not entitled to health care—as well as cultural and linguistic barriers, racism and xenophobia. Migrants and ethnic minorities fear stigma from their communities, yet community acceptance is key for well-being. Conclusions: Migrants and ethnic minorities should be offered HIV testing, but the barriers highlighted in this review may deter programs from achieving the final goal, which is linking migrants and ethnic minorities to HIV clinical care under the public health perspective.