HIV-positive Children Research Articles

Should children know their HIV status? Prevalence, caregiver's perspectives and barriers to disclosure at the National Hospital Abuja, Nigeria.

Nigeria ranks second globally with a HIV/AIDS prevalence of 3.2%. HIV infected children are surviving to adolescence because of anti-retroviral therapy, but many do not know why they need to take these medicines. Disclosure is critical to long-term disease management, yet, if, how and when caregivers and or health professionals disclose to children is not well known in resource-limited settings. The barriers to disclosure remain largely undocumented. To determine the prevalence and age of HIV disclosure to children in Abuja, Nigeria and identify caregivers perspectives as well as barriers to disclosure. A cross-sectional study was done June-July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV-positive children aged 5-16 years receiving antiretroviral therapy for at least 1 year were enrolled. Prevalence of full disclosure was 24.5%, partial disclosure 22.7%, with overall prevalence of 47.2%. Mean age at full disclosure was 11.87 years. Bivariate analysis showed significant difference between disclosure and child's level of education (χ2 for trend 26.710, P < 0.001), support for disclosure (χ2 4.399, P = 0.036) and if caregiver held the opinion that children should have disclosure done (Pearson's χ2 30.174, P < 0.001). However, on logistic regression, only the age of the child (P < 0.001, 95% CI 1.176-1.499) and the caregiver's opinion (P = < 0.001, 95% CI 4.914-2.542) remained significant. Various barriers to disclosure were identified. The prevalence of full disclosure is low and several barriers prevent early disclosure. Caregiver's and HCWs need empowerment with culturally appropriate skills and platforms to increase disclosure rates, which may help improve adherence.

"I prefer not to have a child than have a HIV-positive child": a Mixed Methods Study of Fertility Behaviour of Men Living with HIV in Northern Nigeria.

In the era of HIV treatment as prevention, little research has focused on the fertility behaviour of men living with HIV. This study examines the predictors and motivators of fertility among men living with HIV and on antiretroviral treatment in Kano, Nigeria. Using mixed methods, structured questionnaires were administered to a clinic-based sample of men living with HIV (n = 270) and HIV-negative/untested controls (n = 270), followed by in-depth interviews with a sub-group of 22 HIV-positive participants. Logistic regression and the framework approach were used to analyse the data. Compared to HIV-negative/untested controls, lower proportions of men living with HIV desired more children (79.3%, n = 214 vs. 91.1%, n = 246, p < 0.05) and intended to bear children within 3years (57.0%, n = 154 vs. 67.0%, n = 181) (p < 0.05). Marital status (ever married vs. single) predicted fertility intention among men living with HIV (adjusted odds ratio, AOR = 4.70, 95% confidence interval CI, 1.75-13.64) and HIV-negative/untested controls (AOR = 4.23, 95% CI, 1.37-16.45). Men considered self and partner health status, HIV transmission risks, poverty, the effectiveness of interventions, child survival and religion when making fertility decisions. Fertility desires remain high post-HIV diagnosis. HIV services should include integrated reproductive health programs that address the fertility desires of clients and include considerations for fertility services.

Pattern of Otorhinolaryngological Disorders in HIV Positive Paediatric Patients at the University of Port Harcourt Teaching Hospital (UPTH)

Background: HIV is a worldwide disease and affects all systems of the body. Despite the high burden of Paediatric HIV in Nigeria, few studies have been done on Otolaryngological disorders in children living with HIV. This study aimed to determine the pattern and prevalence of Otorhinolaryngological disorders among HIV positive paediatric patients and to compare them with age and sex-matched control.&#x0D; Methods: This was a descriptive cross-sectional case-control study carried out among 130 HIV positive and 130 HIV negative children aged 6 to 15 years at the University of Port Harcourt Teaching Hospital (UPTH). Eligible patients were recruited via a systematic sampling method and matched with HIV negative controls and an interviewer-administered questionnaire was used to extract relevant information. All patients had Otorhinolaryngological examination and CD4 count determination, while children with tonsillar enlargement underwent X-ray of the post nasal space. HIV patients were graded for severity using WHO clinical Staging.&#x0D; Results: A higher proportion of the HIV positive patients had allergic rhinitis (66.9% vs.30.8%, p=0.01), pharyngitis (40.8% vs.18.5%, p=0.01), tonsillitis (34.6% vs.20.8%, p=0.013), adenotonsilar disease (24.6% vs. 13.8%, p=0.028), cervical lymphadenopathy (15.4% vs. 5.4%, p=0.001) and otitis media (5.4% vs. 0.8%, p=0.031). There was a significantly higher prevalence of ORL disorders among HIV positive children (95.4%) compared to HIV negative children (78.5%). (P=0.001).&#x0D; Conclusion: Pattern of ORL disorder appeared similar in both HIV-positive and -negative children. However, the overall high prevalence of the findings among the HIV-positive children required regular ORL assessment in these children.

Attrition of HIV-positive children from HIV services in low and middle-income countries.

Identification and retention of HIV-positive children in HIV services is essential to ensure optimal health outcomes. This systematic review and meta-analysis examines the magnitude of attrition [loss to follow-up (LTFU) and death) of HIV-positive children from HIV services in low and middle-income countries (LMICs). We performed a comprehensive multidatabase search of original studies reporting retention/attrition data for HIV-positive children in LMICs through April 2016. Outcomes included LTFU, death, and overall attrition (LTFU + death) at intervals up to 60 months of follow-up. At least two authors determined study eligibility, performed data extraction, and made quality assessments. We used random-effects meta-analytic methods to aggregate effect sizes and perform meta-regression analyses. We identified 3040 unique studies; 91 met eligibility criteria and were included in the analysis. This represents 147 129 HIV-positive children; most were from Africa (83%). LTFU definitions varied widely, with significant variability in outcomes across studies. Most attrition occurred in the first 6 months of follow-up, increasing to 23% by 36 months. HIV-positive children receiving antiretroviral therapy (ART) had significantly better retention in care than those not on ART. Studies that performed case-finding/tracing for those LTFU had better retention in care up to 24 months of follow-up. These findings underscore the high attrition of children from HIV services in LMICs. Early ART initiation and decentralized patient support services (e.g. tracing for those LTFU) have potential to improve retention in care. Implementation research and resources are urgently needed to improve retention among this vulnerable population.

An assessment of the nutritional status of ART receiving HIV-orphaned and vulnerable children in South-West Nigeria

IntroductionGood nutritional status is pertinent to the optimal outcome of effective ART among children. Against this backdrop, the objective of the current study is to assess the nutritional indices of children receiving ART in South-West Nigeria. MethodsThe study was cross-sectional in design. We randomly selected three urban and six rural ART sites from the ones offering ART services in Oyo state. All consented children receiving ART treatments in the aforementioned sites participated in the study. A total of 390 HIV-positive children and adolescents aged 6–18 years were interviewed using a semi-structured interviewer-administered questionnaire. Children were assessed and growth curves were constructed using the 2007 World Health Organisation (WHO) growth reference standard for children as well as adolescents. Data were presented using descriptive statistics. ResultsAbout 52% of the children are male, 136 (34.9%) have lost at least one parent, 52 (13.3%) have lost either parent to HIV/AIDS. Among the males, 19%, 27%, and 27% were underweight, stunted and thin, respectively when compared with 17%, 23% and 23%, respectively, among females. The male and female weight-for-age average z-score were (-0.98 vs -1.04), height-for-age (-1.12 vs -1.07), and BMI-for-age (-1.19 vs -1.18). Irrespective of age, sex, parental survival, and residence, weight-for-age and BMI-for-age analysis revealed substantial underweight, with the worst outcomes being among those orphaned by HIV/AIDS. ConclusionAll nutritional indices considered in this study fell short of the WHO standard. HIV positive children in the ART sites included in this study are faced with a high burden of undernourishment despite been placed on daily ART regimens. In addition to efficient ART, interventions to ameliorate poor nutritional status is needed.

Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis

BackgroundApproximately 70% of HIV positive people live in Africa where food insecurity and under nutrition are endemic. However the impact of malnutrition on treatment outcome is not clear. This study assessed the effect of under nutrition on Anti-Retroviral Therapy treatment outcome among pediatric age group living with HIV/AIDS in Public Hospitals, Southwest Ethiopia.MethodA retrospective cohort study was conducted on records of 242 pediatric children in Guraghe zone Public Hospitals. Also median, mean, standard deviation and interquartile range were calculated. Life table, hazard function and survival function were plotted. Log rank test with 95% confidence interval of mean survival time was done. The nutritional status data were managed via WHO Anthros plus and BMI for age Z score was calculated. To assess effects of nutritional status on mortality, both Bivariate and multivariate cox proportional hazard regression was conducted with crude (CHR) and adjusted hazard ratio (AHR) (95% confidence interval and p value). P value of less than 0.05 was used as cut off point to declare statistical significance.ResultsA total of 243 records of pediatric ART records with mean age of 11.6 (± 3.8 years) were reviewed. About 178 (73.3%) have got therapeutic feeding on the course of ART treatment. Whereas significant number of children, 163 (67.1%) reported to had eating problems. A total of 13 (5.3%) children were dead with incidence density of 11.2 deaths per 1000 person years. There is significantly higher survival time among well nourished (11.1 years with 95% CI: 10.8 to 11.4) as compared to underweight children (9.76 with 95% CI: 9.19 to 10.32 years). Underweight children had almost three fold increase incidence of death (AHR = 3.01; 95% CI: 0.80–11.4). Similarly children with anemia had higher incidence of death than children without anemia (AHR = 1.55; 95% CI: 0.49–4.84).ConclusionsLow nutritional status at the start of ART evidenced by underweight and anemia were found to be predictors of survival among HIV positive children. There should be improved, sustained and focused nutritional screening, care and treatment for children on ART follow up.

Prevalence of Enteric Bacteria Pathogens among HIV Infected and Uninfected Children in Dandora, Kenya

Background: Diarrhoea is the second disease killer after respiratory diseases in children. Globally, there are nearly 1.7 billion cases of diarrheal disease every year. In developing countries, enteric bacterial pathogens are most common causes of morbidity and mortality in children especially under 5 years. Most of the studies done on enteric bacteria pathogens and HIV co-infection have focused on the children less than 5 years of age but not above.&#x0D; Objective: This study aimed at evaluating the distribution of common circulating enteric bacterial pathogens; Escherichia (E).coli, Shigella, and Salmonella among HIV infected (n=79) and uninfected (n=78) children aged 5-12 years from Dandora slums of Nairobi.&#x0D; Methods: This was analytic cross-sectional study of HIV positive children enrolled at Nyumbani Lea Toto HIV/AIDS outreach program in Dandora, while HIV negative are children from same area (preferably sibling). Stool samples were collected from consenting participants and sent to Microbiology laboratory in Kenya Medical Research institute for processing. The samples were cultured using differential media for enteric bacteria. Suspected isolates were further identified using conventional biochemical methods and serology. Multiplex PCR was done on E. coli isolates to detect virulence factors responsible for different E. coli pathotypes.&#x0D; Results: The overall prevalence of pathogenic Escherichia coli, Shigella and Salmonella was 44 (28%), 31 (19.7%) and 0 (0.0%) respectively. Enteroaggregative E.coli (43.2%) was the main E. coli pathotypes observed. Distribution of pathogenic E. coli in HIV infected and uninfected was 12.7% and 15.3%, respectively (p = 0.30), while that of Shigella was 6.4% and 13.4% (p = 0.03).&#x0D; Conclusion: From this study HIV infected children had less infestation of Shigella species as compare to HIV uninfected children, which could be due to constant treatment for any infections thus interferes with bacteria grow.

Enterobacteria in the intestinal microbiocenosis of hivinfected children

Aim. The purpose was to assess the species composition, virulence factors and the nature of the interaction of Enterobacteria with intestinal microsymbionts in HIV-positive children.Material and methods. The composition of intestinal microbiocenosis of 89 HIV-infected children (main group) and 74 children without HIV status (comparison group) was studied. 273 strains of Enterobacteria were isolated and identified to the species. The frequency and level of expression of adhesion, invasion, toxin formation and antagonism factors were studied.Results. In HIV-positive children colonization rate of intestinal mucosa E. coli lac — was 5 times higher, E. coli hly+ 1.5 times higher than in the comparison group. The quantitative level of opportunistic enterobacteria increases with the aggravation of microecological disorders, 98% of enterobacteria forms a many-to-many association. Of these, 86.8% are neutral towards other symbionts. The frequency and level of production of adhesion, invasion and toxin formation factors did not differ in the compared groups.Conclusion. In HIV-infected children is formed enterobacteriales type microbiota. Biological properties of enterobacteria did not depend on the presence of HIV status in children.

Adaptation and validation of a brief DSM-5 based psychiatric rating scale for childhood and adolescent mental health in Uganda: the Child and Adolescent Symptom Inventory-Progress Monitor (CASI-PM)

ABSTRACT We describe the process of locally adapting and validating the international psychiatric symptom screening instrument, the Child and Adolescent Symptom Inventory-Progress Monitor-parent version (CASI-PM-P) for use among youth in the sub-Saharan African setting of Uganda. To do this we used a methodology similar to that employed by the developers of this instrument. These analyses were undertaken among both a clinical sample (1,339 HIV positive children and adolescents attending HIV care services in central and south-western Uganda) and a standardised sample (consisting of 323 HIV negative children and adolescents attending government schools in central Uganda). Pearson’s correlations, Cronbach’s alpha and analyses of variance were used to assess the reliability and validity of the adapted instrument. On item selection, 18 (64%) of the 28 psychiatric symptom items in the derived instrument showed large to moderate item-to-total minus item correlations. There was concordance on 17 (61%) of the psychiatric symptom items between the original version of the CASI-PM-P and the Uganda version. The selected psychiatric variable items in the derived version of the CASI-PM-P showed stability across age groups (children and adolescents), time (baseline and 6 months) and samples (clinical sample and standardised sample). The instrument showed good construct validity. In conclusion, the 29-item CASI-PM-P can, therefore, be used in the sub-Saharan African setting to screen for and monitor the progress of psychiatric symptoms among youth. However, the selection of the specific variable items to constitute a local version of the CASI-PM-P should be guided by local adaptation and validation studies.

Clinico-Epidemiological Profile of Children Orphaned due to AIDS Residing in Care Giving Institutions in Coastal South India.

Background HIV/AIDS has a greater impact on children. Besides being orphaned by the untimely demise of one or both parents due to the disease, these children are more prone for discrimination by the society. Methods In this cross-sectional study 86 children orphaned by AIDS residing in care giving institutions for HIV positive children in Mangalore were assessed for their clinico-epidemiological profile and nutritional status. Institutional Ethics Committee clearance was obtained before the commencement of the study. The collected data were analyzed using SPSS (Statistical Package for Social Sciences) version 11.5 and the results expressed in mean (standard deviation) and proportions. BMI was calculated and nutritional status assessed using WHO Z scores (BMI for Age) for children between 5 and 19 years separately for boys and girls. Results The mean age of the children was 13.2 ± 3 years. Majority (n = 56, 65.1%) of the children were double orphans. Most of the children orphaned by AIDS (n = 78, 90.7%) had a history of both the parents being HIV positive. The median CD4 count of participants at the time of our study was 853.5 (IQR 552–1092) cells/microliter. A higher percentage of orphans were malnourished compared to nonorphans. (41.1% vs. 36.7%). All the educational institutions, wherein the children orphaned by AIDS were enrolled, were aware about their HIV status. Five of the participants felt discriminated in their schools. Only two of the participants felt discriminated by their friends because of their HIV status. Conclusion From our study we draw conclusion that even though the children orphaned due to AIDS are rehabilitated in terms of having shelter and provision of education and health care, much needs to be done in terms of improving the nutritional status of these children and alleviating the discriminatory attitude of the society towards them.

Lipid abnormality correction by integrase inhibitor among children taking ARt

Goal. To estimate a possibility of correction laboratory abnormalities (increased level of cholesterol and/or triglycerides at blood of HIV-positive children) by switch the boosted PI on HIV integrase inhibitor (Raltegravir). Methods. The retrospective study was conducted in group of 58 HIV-positive children (less 18 yo). Inclusion criteria were increasing level of cholesterol in blood (more than 5,0 mmol/l) and/or the triglyceride (more than 2,3 mmol/l) ART with boosted PI. The ART regime was changed for all children (n=58). Boosted PI was replaced to integrase inhibitor (RAL). RAL formulation (chewable tablets, 25mg and 100mg) used accordingly weight. Time horizon of observation and laboratory control after boosted PI switch was 24 months. Results. Lab abnormalities in study group (n=58) after switch to RAL were changed: reliable decrease in level of cholesterol (p &lt;0,01), triglycerides (p &lt;0,001), viral load (p &lt;0,001) and growth CD4 count (p &lt;0,05). Conclusion. Boosted PI switch to integrase inhibitor is providing long-term and effective HIV management and improvement of lipid abnormalities among children.

Dietary intake among paediatric HIV-positive patients initiating antiretroviral therapy in Johannesburg, South Africa

ABSTRACT In South Africa, prevention of mother to child transmission (PMTCT) has reduced MTCT from 3.6% in 2011 to 1.3% in 2017. However, there are challenges in reaching vulnerable HIV-positive children; those at increased risk of malnutrition or present late with advanced disease. Macro – and micronutrient deficiencies, common in HIV, may accelerate disease progression. This was a prospective cohort study of paediatric patients (aged 1–10 years) initiating ART between 08/2014 and 09/2016 at a public health facility in Johannesburg, South Africa. Trained clinic staff collected anthropometric indices and dietary intake at ART initiation and at one and three months post initiation. A blood sample was collected at ART initiation and at six months post initiation for biochemistry. We describe demographics, anthropometry, dietary intake, dietary diversity at enrolment and changes in anthropometry and biochemistry from ART initiation until six months for paediatric HIV-positive patients initiating antiretroviral therapy (ART). Twenty-seven patients were enrolled. The World Health Organization dietary intake recommendations for children were not met for the majority of nutrients including energy, fats, iron, calcium and Vitamin A at ART initiation. At least 40% of patients were receiving less than four of the main food groups. At initiation, 18.5% of children presented with severe acute malnutrition (MUAC <11cm), 14.3% were underweight (weight-for-age Z score <-2SD), 19.1% stunted (height-for-age Z score <-2SD) and 33.4% were wasted (weight-for-height <-2SD). At six months, there was a general increase in WHZ (<5 years), BMI (≥5 years), C-reactive protein, iron and albumin but a significant increase in Vitamin A. The results highlight the need for dietary counselling and provision of nutritional supplementation at ART initiation for paediatric patients. Adequate nutrition should be established early at initiation, to improve growth, development and health outcomes.

Diagnostic accuracy of 3-T lung magnetic resonance imaging in human immunodeficiency virus-positive children.

More than 70% of human immunodeficiency virus (HIV)-positive children sustain respiratory diseases in their lifetime. Imaging plays an important role in establishing early and correct diagnosis. To evaluate the diagnostic accuracy of 3-Tesla (T) thorax MRI in HIV-positive children, using chest CT as the gold standard. We included 25 children with confirmed HIV-positive status and pulmonary complaints who were referred for chest CT. All children had 3-T thorax MRI using T2-W turbo spin-echo sequence, steady-state free precession gradient echo sequence, T2-W turbo spin-echo MultiVane XD sequence, and T1-weighted modified Dixon sequences. We evaluated the images for various pulmonary and mediastinal findings and calculated the sensitivity and specificity of 3-T thoracic MRI. Sensitivity of 3-T MRI was 100% for detecting nodules >4mm (95% confidence interval [CI] 66.3-100%), pleural effusion (CI 29.2-100%) and lymphadenopathy (CI 81.5-100%). It demonstrated a specificity of 100% for nodules >4mm (CI 79.4-100%), pleural effusion (CI 84.6-100%) and lymphadenopathy (CI 59-100%). For consolidation/collapse, sensitivity and specificity were 93.8% (CI 69.8-99.8%) and 88.9% (CI 51.8-99.7%), respectively. The sensitivity and specificity for detecting bronchiectasis were 75% (CI 42.8-94.5%) and 100% (CI 75.3-100%), respectively, while for ground-glass opacity, sensitivity and specificity were 75% (CI 34.9-96.8%) and 94.1% (CI 71.3-99.9%), respectively. Nodules <4mm were not well detected on MRI, with sensitivity of 35% (CI 15.4-59.2%). Thoracic MRI at 3T demonstrates a high sensitivity and specificity for detecting nodules >4mm, effusion and lymphadenopathy in HIV-positive children.

Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa

BackgroundLoss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure.MethodsSecondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed.ResultsOf the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB. Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no statistically significant differences in baseline characteristics between HIV positive infants who returned for an exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst these HIV positive children < 18 months would be 43.6%.ConclusionsEarly ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014.

Childhood tuberculosis and treatment outcomes in Accra: a retrospective analysis

BackgroundTuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana.MethodsA retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality.ResultsOut of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1–4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality.ConclusionThe proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.

Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa.

Limited research investigating treatment outcomes for HIV-positiveorphans compared with non-orphans has shown mixed results, with several studies indicating that HIV-positive orphans are at greater risk of delayed access to HIV care and poor antiretroviral therapy (ART) adherence, while other data suggest that ART outcomes of orphans can be similar to those of non-orphans. Understanding the impact of orphan status on short-term ART outcomes could improve targeted intervention strategies, and subsequent long-term treatment and developmental outcomes, for HIV-positiveinfants, children and adolescents. To evaluate the relationship between orphan status and ART outcomes among HIV-positive infants, children and adolescents initiating ART at two large public sector HIV clinics in Johannesburg, South Africa. This was a retrospective cohort study of HIV-positivechildren aged &lt;18 years initiating standard first-line ART between June 2004 and May 2013. Using propensity scores, orphans and non-orphans were matched for age, sex, World Health Organization stage and ART regimen. The effect of orphanhood on attrition from care (all-cause mortality and loss to follow-up) was evaluated using Cox proportional hazards regression analysis, and its effect on having a detectable viral load (≥400 copies/mL) at 12 months on ART using binomial regression analysis with modified Poisson distribution. A total of 251 (29.4%) orphans (maternal, paternal or both) and 603 (70.6%) non-orphans were included at ART initiation. Following multiple imputation for missing data and propensity score matching, 222 orphans and 222 non-orphans were included. Orphans had a median age of 8.0 years (interquartile range (IQR) 4.9 - 10.7) and non-orphans 7.4 years (IQR 4.2 - 10.2). A total of 12 (5.4%) orphans and 33 (14.9%) non-orphans experienced attrition from care during the first 12 months on ART (adjusted hazard ratio 0.32, 95% confidence interval (CI) 0.17 - 0.63). Among those alive and in care, with a viral load at 12 months on ART, 18.0% of orphans (33/183) and 14.8% of non-orphans (24/162) had a detectable viral load (adjusted risk ratio 1.15, 95% CI 1.04 - 1.28). Orphans were less likely than non-orphans to experience attrition, but among those in care at 12 months, orphans were more likely to have detectable viral loads. Lower attrition among orphans may be due to their being in institutional or foster care, ensuring that they make their visits; however, their higher rates of non-suppression may result from lack of psychosocial support or stigma resulting in struggles to adhere. Additional research investigating age-specific outcomes will be important to elucidate these effects further.

Epidemiologic and clinical findings of children with acquired immunodeficiency syndrome in four provinces of Iran.

The human immunodeficiency virus (HIV) is still aremarkable challenge throughout the world, especially in developing countries. Despite the fact that HIV in children is becoming one of the most challenging diseases, it seems that pediatric AIDS in Iran is an unknown disease and there is alack of studies about it. The aim of this study was to describe the characteristics of HIV-positive children who referred to the hospitals of Tehran, Kermanshah, Kurdistan, and Qom provinces of Iran. This study was aretrospective investigation of medical records among 61children with adiagnosis of HIV who were admitted to the children's hospitals in the four provinces of Iran during a3-year period (2013-2016). The frequency of HIV in the center of Iran (Tehran and Qom provinces) was higher (N = 37, 61%). Most of the infected patients were between 5 and 15years old, 52% were male, and 93% had ahistory of HIV in their family. Median age at diagnosis of HIV was 2years. Most of the hospitalized patients were discharged and only two patients (3%) died due to HIV infection. The vast majority of patients (93%) were infected through maternal transmission and alow percentage (29%) were diagnosed before 1year of age. All of them were in the third stage of the disease. All patients had apositive HIV PCR test. HIV EIA was positive in the majority of cases (98%). Ahistory of addiction in the family was demonstrated in 22cases (36%). Weight loss (N = 51, 84%), prolonged fever (N = 50, 81%), and respiratory infection (N = 26, 47%) were the most common symptoms. This study demonstrated a high frequency of pediatric HIV among children aged 5-15years in four provinces of Iran. Novel strategies to prevent and eliminate mother-to-child transmission of HIV, diagnostic facilities, and treatment of infected mothers during pregnancy in our country are highly recommended.

Adherence to combination antiretroviral therapy among orphaned children in Dar es Salaam, Tanzania.

BackgroundAdherence to combination antiretroviral therapy (cART) among HIV-infected children is often complicated by various factors including medication formulation, dosing frequency, drug toxicities, age and developmental stage, psychosocial and behavioural characteristics of both children and caregivers and can additionally be complicated by being an orphan.ObjectivesThis study was aimed at determining the factors and the extent of their influence on cART adherence among HIV-infected orphaned children attending Care and Treatment Centres (CTCs) in Dar es Salaam, Tanzania.MethodsA cross-sectional study was performed, which assessed adherence in HIV-positive orphaned children aged 2–14 years receiving nevirapine (NVP) based cART for at least 6 months. Data was collected using questionnaires administered to primary caregivers of HIV-infected orphaned children, the review of medical files, and the laboratory measurement of NVP plasma concentrations and CD4 counts. Adherence to cART was determined based on caregivers’ self-report, consistency of clinic attendance and NVP plasma concentrations.ResultsAmong the 216 enrolled orphaned children, adherence to cART was found to be 79.6%, 82.9% and 72.2% respectively based on caregivers’ self-report, clinic attendance and NVP plasma levels. Significant reductions in NVP concentrations (< 3 µg/mL) were seen among children with poor immunological outcomes, poor clinic attendance (p < 0.05) and were suggested by caregivers’ self-reported adherence (p = 0.06). Adherence challenges identified by caregivers included financial constraints (87.5%), lengthy waiting times at clinics (75.5% spent > 2 h at the clinic) and low HIV knowledge among caregivers.ConclusionSignificant numbers of HIV-infected orphans have poor adherence to cART ranging between 17% and 28% based on different assessment methods. Inadequate caregiver knowledge of HIV/AIDS, long clinic waiting times and forgetfulness were identified as barriers to cART adherence in these orphans.

Disclosure of HIV Status to Children in Sub-Saharan Africa: A Systematic Review.

Background and objectives: This study aimed to assess the level of HIV disclosure to children in sub-Saharan Africa as it relates to prevalence of disclosure, barriers, merits and demerits, timing of disclosure, and factors that promote parents and caregivers’ decisions to disclose the information. Materials and Methods: A systematic literature search was performed using the following online databases: PubMed, Google Scholar, Web of Science, Scopus, and Embase, to obtain relevant articles on HIV disclosure to children in sub-Saharan Africa. The following search terms were used: “HIV” AND “Disclosure” AND “Sub-Saharan Africa” AND “Children”. Results: A total of 18 articles were included in this systematic review. The studies on HIV status disclosure to children in sub-Saharan Africa included a total of 1343 HIV-positive children and 1879 caregiver/child or healthcare worker-child dyads, from the following countries: Ethiopia, South Africa, Ghana, Kenya, Cote d’Ivoire, Burundi, Cameroon, Democratic Republic of Congo, Uganda, Burkina Faso, and Zambia. The prevalence of HIV disclosure ranged from as low as 9% to 72%. Age was a major factor associated with disclosure. Conclusions: HIV status disclosure to children is quite low in sub-Saharan Africa. This is a result of multiple factors such as parents’/caregivers’ fear of the child disclosing status to others, a lack of knowledge on how the disclosure should be made, and the assertion that the children are young and cannot withstand the psychological impact of diagnosis.

HIV Positivity and Referral to Treatment Following Testing of Partners and Children of PLHIV Index Patients in Public Sector Facilities in South Africa.

BackgroundThere is an imperative need for innovative interventions to identify people living with HIV and initiate them on antiretroviral therapy (ART). The objective of this study was to determine the feasibility of providing index partner/child testing of people living with HIV.MethodsWe trained 86 nurses and counsellors in 56 public health facilities in six high HIV burden Districts in 2017 to provide index partner/child testing (tracing and testing of partners/children of people living with HIV). We collected programmatic data including index partner/child HIV positivity by age, gender and location of testing. In sub-analyses, we evaluated factors associated with identifying HIV-positive partners and children in separate models using multivariable logistic regression.ResultsWe tested 16,033 partners and children of index patients between October 2017 and June 2018. Most of those tested were female (61%) and 20–39 years old (39%). Overall, 6.4% were 10–14 years old, 9.5% were 15–19 years; 8% were >50 years. HIV positivity was 38% (95% CI=36%−40%). In children ages 10–14, 13% were HIV-infected (95% CI=11%−14%). In subanalyses, HIV positivity in partners was associated with their increased age (adjusted odds ratio [aOR] for increase in 5-year age category=1.21; 95% CI=1.04, 1.42), female gender (aOR=1.38; 95% CI=1.04, 1.82) and bringing the partner in for HIV testing vs. referring the partner through the provider or recommending testing to the partner (aOR=1.94, 95% CI=1.43, 2.63), adjusting for location of testing. Almost all patients diagnosed (97%) were referred to ART.ConclusionProviding index partner/child testing was feasible and we identified a very high yield when testing partners/children of index patients. Index partner/child testing should be offered to all patients living with HIV to improve case finding.