HIV-positive Children Research Articles

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.

Caring for HIV-positive children: healthcare providers' pre-and post-disclosure experiences in Nairobi, Kenya

Background The number of children living with HIV has increased worldwide, largely due to improvements in antiretroviral therapy. Most of these children are living in sub-Saharan Africa. The rate of disclosure to children of their HIV-positive status is low in low-resource countries compared to high-resource countries. Aim To explore health professionals' experiences of caring for HIV-positive children before and after their HIV-positive status was disclosed to them. The health professionals included nurses, counsellors, nutritionists, social workers, pharmacists and clinicians with at least 1 year of experience at the paediatric section of the comprehensive care centre. Methods Nine health professionals were interviewed. Findings Results revealed that there were more challenges before disclosure than after. The main challenge was communicating with the children. The children's main concerns before disclosures included the reason for treatment and its duration, and clinic follow-up. Conclusions Health professionals should be trained on the benefits of HIV disclosure to children, in order to allow for open and direct communication between healthcare providers, parents/carers and children.

Incidence and predictors of tuberculosis among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia: a retrospective follow-up study.

OBJECTIVESTuberculosis (TB) is common in children with human immunodeficiency virus (HIV), but its effect on the survival of HIV-infected children is not well understood. Therefore, the aim of this study was to assess the incidence and predictors of active TB among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia.METHODSA retrospective study was conducted over 5 years using a checklist to gather data from 428 randomly selected pediatric patient charts. The checklist was adapted from the standardized antiretroviral therapy (ART) follow-up form currently used by the institution’s ART clinic. Data were analyzed by bivariate and multivariable analysis using Cox regression proportional hazards models, as appropriate. Survival was calculated and compared using the Kaplan-Meier and log-rank tests.RESULTSOf the 466 charts reviewed, 428 patient records were included in the analysis. A total of 67 new TB cases were observed during the follow-up period. Hence, the incidence rate in this cohort was found to be 6.03 per 100 child-years of observation. A baseline hemoglobin level <10 g/dL (adjusted hazard ratio [aHR], 7.04; 95% confidence interval [CI], 1.03 to 48.15), moderate wasting (aHR, 2.86; 95% CI, 1.02 to 7.99), and not receiving isoniazid preventive therapy (aHR, 8.23; 95% CI, 2.11 to 32.06) were among the independent predictors of TB occurrence.CONCLUSIONSThe incidence of TB was high, particularly in pre-ART patients receiving chronic care for HIV. Close followup of HIV-positive children is crucial to protect them against the development of TB. Initiating isoniazid preventive therapy, averting malnutrition, and managing anemia are also of significant importance.

A comparison of adherence to antiretroviral therapy amongst adolescent patients of the Baylor International Pediatric AIDS Initiative Children’s Centers of Excellence before and after attendance at recreational therapy camp

ABSTRACTAdherence rates among adolescents to antiretroviral medications are poor and average well below the accepted optimal level of greater than 95%. Attendance at recreational therapy camp (RTC) offers a potential mechanism for addressing these adherence issues. The present study investigated the effect of RTC on adherence to antiretroviral therapy, assessed by pill counts on a cohort of patients from the Baylor International Pediatric AIDS Initiative sites in Lesotho, Eswatini, Malawi and Uganda. CD4 counts before and after RTC were compared as secondary endpoints. RTC took place over one to two weeks. Out of 448 children enrolled into RTC between 2012 and 2015, informed consent and adequate adherence data were obtained on 409 children. During the first 6 months following RTC, significantly more attendees had pill counts indicating adherence consistently greater than 95%, compared to the 6 months prior to RTC (p = 0.023). This improvement was not maintained during the second six months following RTC (p = 0.374). This study indicated some potential short-term benefit in terms of adherence to antiretroviral medications for HIV-positive children attending RTC.

Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status-A Cross-Sectional Study.

Fatty acids (FAs) are crucial in child growth and development. In Uganda, antiretroviral therapy (ART) has drastically reduced perinatal human immunodeficiency virus (HIV) infection of infants, however, the interplay of FAs, ART, and HIV in relation to child growth is not well understood. To investigate this, serum was collected from 240 children between 6–10 years old in Uganda and analyzed for FAs using gas-chromatography mass-spectrometry. HIV status and anthropometric measurements were taken, and relationships with FAs were assessed. No significant differences in growth parameters or serum FAs were found between HIV uninfected children with and without exposure to ART. HIV positive children had significantly lower height-for-age-z-scores (HAZ) than uninfected children (p < 0.001). HIV-positive children had higher arachidonic acid than uninfected children (p = 0.003). Total omega-6 FAs were significantly associated with HAZ regardless of HIV status (p = 0.035). Mean total omega-3 FAs (2.90%) were low in this population compared to other cohorts in Africa. These results provide reference serum FA values for 6–10-year-old children in Uganda and may be used to inform lipid supplementation programs to promote child growth. Future studies should investigate the relationships between child growth trajectories in relation to HIV status and serum FAs.

The prevalence and process of pediatric HIV disclosure: A population-based prospective cohort study in Zimbabwe.

IntroductionThe objective of this study was to estimate the prevalence of pediatric HIV disclosure in rural Zimbabwe and track the process of disclosure over time.MethodsWe recruited a population-based sample of 372 caregivers of HIV-positive children ages 9 to 15 to participate in a survey about disclosure. Using data from this cross-sectional sample, we then identified a prospective cohort of 123 caregivers who said their HIV-positive child did not know his or her HIV status, and we followed this non-disclosed cohort of caregivers through two additional waves of data collection over the next 12 months. At each wave, we inquired about the timing and process of disclosure and psychosocial factors related to HIV disclosure.ResultsThe overall prevalence of disclosure in the cross-sectional sample was 66.9% (95% CI 62.0 to 71.5%). Only 26.9% of children knew how they were infected and that they can transmit the virus to others (i.e. “full disclosure”). Older children were more likely to know their status. Among the non-disclosed caregivers at baseline, nearly 60% of these children learned their HIV status over the course of the 12-month study period, but only 17.1% learned how they were infected and that they can transmit the virus to others. Most caregivers were satisfied with their child’s disclosure experience. Caregivers who had not disclosed their child’s HIV status to the child worried that disclosure would lead to stigma in the community, provoke questions from their child they would not be able to answer, or cause the child to reject the caregiver in anger.ConclusionsThis study suggests that rates of pediatric HIV disclosure may be larger than typically reported, but also reinforces the idea that most children do not know key details about their illness, such as how they were infected and that they can infect others.

Living with HIV/AIDS: A Qualitative Study to Assess the Quality of Life of Adolescents (13-19 Years) attending ART Centre of Selected Hospital in New Delhi

Introduction: Adolescents are the vulnerable group likely to have multiple interacting factors affecting their quality of life especially in Indian setting which has a large population of HIV positive children. Therefore, in order to understand the lived experiences and challenges faced by adolescents a Qualitative study was conducted to assess the QOL (Quality of Life) of Adolescents living with HIV/AIDS (ALWHA) under 3 domains: Psychological, Social & Spiritual. The research questions assessed were: What are the psychological experiences of ALWHA, What are the social experiences of ALWHA? How has the diagnosis of the illness affected the day to day life of ALWHA? What challenges do the adolescents face in their day to day life as a person living with HIV/AIDS? Methods: A Qualitative approach with phenomenological design was implemented. Participants were selected through purposive sampling technique and data was collected using semi-structured interview schedule. Result & Conclusion: Data was analyzed using thematic analysis and subsequent themes, sub-themes and categories emerged, which were: Reluctance to disclosure of HIV status, Experiences with Disclosure, Social Support, Spiritual well being, Difference in living with the disease before and after disclosure, Positive Living and Sexuality and Shame. The participants in this study had several resources at hand, including the treatment facilities and social support, which contributed to the acceptance of the disease condition and a positive living. Thus, it showed that ALWHA had an overall good QOL.

Tracking Progress Toward Elimination of Mother to Child Transmission of HIV in Zambia: Findings from the Early Infant Diagnosis of HIV Program (2009-2017).

BackgroundWe carried out analyses of early infant testing results at Livingstone Central Hospital in Zambia to assess time of testing, linkages to care and availability of test results for clinical decision making.MethodsWe abstracted data from registers of HIV-exposed infants who had dried blood spots cards (DBS) collected for DNA-PCR from January 2009 to December 2017. Only those tested from 2014 to 2017 had additional data which were used to estimate risk factors for mother-to-child HIV transmission using logistic regression models.ResultsDBS were collected from 2630 children. The proportion of HIV-positive tests decreased from 21% in 2009 to 2% in 2016 and 2017. Median turnaround time for results was 9 weeks (IQR: 5, 15) for HIV-negative, 7 weeks (IQR: 5, 13) for HIV-positive children. Only 2% of infants whose mothers took antiretroviral therapy (ART) were HIV positive, while 18% of infants whose mothers took short course antiretroviral drugs (ARVs) were infected. Infants of mothers who did not take ARVs had 9 times the odds of an HIV positive test (OR = 8.9, 95% CI: 3.6, 22.6). Infants of mothers who received short course ARVs were 40% less likely to get an HIV test within the first 2 months of life (OR = 0.6, 95% CI: 0.4, 0.9) compared to infants of mothers who received ART. Only 52% had a third test at median age 52 weeks (IQR: 50, 54).ConclusionsLong turnaround time for test results and low retention in care after the initial HIV test were critical challenges to clinical decision making.

Association of Antiretroviral Drug Regimen With Viral Suppression in HIV-positive Children on Antiretroviral Therapy in Eswatini.

Global pediatric treatment goals are for 90% of known children living with HIV to be on antiretroviral therapy (ART), with 90% having viral suppression. We used enrollment data from a study evaluating a family-centered HIV care program in Eswatini to describe the ART histories and virologic outcomes of enrolled children living with HIV and identify factors associated with viral suppression (<1000 RNA copies/mL) and undetectability (<400 RNA copies/mL). Factors associated with viral suppression and undetectability were identified using Pearson χ for categorical variables and Wilcoxon rank sum tests for continuous variables. Three hundred seventy-seven children were enrolled, median age 8.5 years. Median age at HIV diagnosis was 2.1 years; at ART initiation, 2.6 years; and ART duration at enrollment, 4.1 years. Ninety-nine percent were receiving ART; 95.2% were on first-line ART and 4.8% on second-line ART. Most children (43.1%) were receiving nevirapine-based ART (median age 9.2 years), with 31.3% on lopinavir-ritonavir-based (median age 5.4 years) and 25.5%, efavirenz-based ART (median age 10.3 years). Viral suppression (<1000 copies/mL) was observed in 77.9% and undetectability (<400 copies/mL) in 73.5% of children. The only factor significantly associated with viral suppression was ART regimen, with 72.1% of children on nevirapine-based ART versus 86.7% on efavirenz-based ART virally suppressed. Although 99% of children enrolled in the study were receiving ART, viral suppression was observed in only 77.9%, with lowest rates among children receiving nevirapine-based ART. These findings highlight the critical importance of monitoring treatment regimen for optimizing treatment outcomes for pediatric HIV.

Contribution and Constraints for the Involvement of People Living with HIV in HIV Prevention and Control Activities: A Qualitative Study at Mandalay Region, 2016

There were nearly 170 positive self-help groups of people living with HIV (PLHIV) in 2013 in Myanmar. This study was conducted at Mandalay City and two townships from Mandalay Region during 2016 to assess the contribution of PLHIV in HIV prevention and control related activities, and identify the challenges for the sustainability of their contribution. Seven focus group discussions with six to seven PLHIV in each group, eight indepth interviews with leaders of HIV positive groups, and two key informant interviews with team leaders of HIV/AIDS were conducted. The average age of respondents was 40 years, male and female ratio was 1:5. The average years of involvement in HIV/AIDS-related activities was 4 years. Generally, PLHIV were very supportive especially to the AIDS/ STD teams which have limited human resources. The achievement of PLHIV involvement could be mainly seen in condom promotion and distribution to vulnerable groups, HIV-test counseling, supporting PLHIV from hard-to-reach areas and with poor socio-economic conditions, assisting in antiretroviral therapy (ART) provision at AIDS/STD teams, home-based care for the HIV positive adult and children, and referring people to get HIV tested and ART treatment. Areas and activities which need to be focused were also reported. The key challenges for the sustainability of their contribution were poor resource of basic equipments and facilities especially the place and funding for office, the lower interest of PLHIV and poor technical knowledge to develop income generation activities, the changing attitudes of PLHIV on their involvement, and uncertain future plans of PLHIV groups. To conclude, the challenges among PLHIV groups should be addressed by National AIDS Programme.

Prevalence of HIV infection among siblings of HIV positive children in Calabar, Nigeria.

IntroductionEarly diagnosis and treatment of paediatric HIV is key as mortality of untreated patients is very high in the first two years of life, and reaches 80% by four years. Case finding efforts for children especially outside Prevention of mother-to-child transmission (PMTCT) is inadequate. Targeting siblings of index HIV-exposed and infected children is an important way of improving identification and enrolment into care thereby reducing paediatric mortality. The study therefore aimed to determine the prevalence of HIV infection among siblings of HIV positive children in care in Calabar.MethodsThis descriptive cross-sectional study was conducted among children aged six weeks to 15 years who are siblings of HIV positive children receiving care. Parental consent and child assent were obtained, the children were tested for HIV at their homes irrespective of their prior test results. Ethical clearance certificates were obtained from the health institutions.ResultsSiblings of 401 index patients were tested for HIV, four were positive giving a prevalence rate of 1%. Three hundred and sixty-seven 367(91.5%) had been tested previously while 34(8.5%) never had HIV test. Among the siblings who were HIV positive, 1(0.3%) was a male while 3(0.7%) were females. There were more HIV positive siblings in the 11-15 years age group.ConclusionAll the four HIV positive siblings were from the lower socioeconomic class (p=0.022). The routine screening of siblings of HIV positive children should be sustained with focus on adolescents from the lower socioeconomic class. This will improve early identification and enrolment into care thereby reducing paediatric mortality.

The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case–control study

ABSTRACTServices that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.

SYMPTOMS OF TUBERCULOSIS IN HIV POSITIVE CHILDREN AND THE IMPACT OF PREVENTION ON THE DEVELOPMENT AND COURSE OF THE DISEASE

The objective of the study: to compare the clinical and X-ray signs of tuberculosis in HIV positive and HIV negative children, to identify factors that are more common in HIV infected children in the region with a high prevalence of both infections. Subjects and methods. 264 children with tuberculosis, and 41 children with HIV infection and tuberculosis undergoing inpatient treatment were enrolled in the study, which was the retrospective study of medical records. The patients underwent standard clinical and X-ray examinations, and microbiological tests. Results. Disseminated forms of tuberculosis (39.1%), tuberculous meningoencephalitis (4.9%) were more frequent in the HIV positive children, while in HIV negative children, it made 1.9 and 0.4% respectively. Among HIV positive children, 34% had several sites of tuberculosis, and 19.5% suffered from generalized forms. In HIV positive children, tuberculosis was more often detected in the infiltration phase, it was accompanied by severe intoxication symptoms, while when taking anti-tuberculosis therapy in combination with ART, they had more rapid positive changes.

Mucocutaneous manifestations of human immunodeficiency virus (HIV) infection in children in relation to the degree of immunosuppression.

Human immunodeficiency virus (HIV) infection in children is becoming a common occurrence. Worldwide, limited studies have been done on the mucocutaneous manifestations in HIV-positive children. The aim of our study was to analyze the spectrum of mucocutaneous manifestations of pediatric HIV infection and correlate to degree of immunosuppression. One hundred and sixty-five children under 18years with HIV, who presented to the departments of dermatology and pediatrics, were examined for mucocutaneous manifestations. Patients were classified into four groups of immunodeficiency such as normal, mild, advanced, and severe, based on NACO guidelines of immunosuppression. The most recent CD4 count (within 6months of study period) was considered. One hundred and sixty-five patients were examined, and skin manifestations were seen in 100 (61%) of them.The highest incidence of mucocutaneous manifestations was in 6-10 age group. Papular pruritic eruptions (PPE) (16%) was the most common condition, with highest prevalence in severe CD4 category (38%). Molluscum contagiosum (MC) (10%) was the most common infectious condition, with highest prevalence in advanced CD4 category (14%). Severe cutaneous adverse reactions (SCAR) caused by nevirapine were seen in three children. The percentage of skin manifestations was highest in the advanced (107%) and severe (100%) CD4 category. There was no significant difference in manifestations between those who were on antiretroviral therapy (ART) and those not. The percentage of skin manifestations increased with degree of CD4 depletion. PPE was found to be the hallmark of severe immunosuppression. However, opportunistic infections did not correlate with severity of immunodeficiency.

Decreased Prevalence of Rheumatic Heart Disease Confirmed Among HIV-positive Youth.

There is geographical overlap between areas endemic for rheumatic heart disease (RHD) and those endemic for HIV. A recent pilot study demonstrated that children living with HIV might be at less risk for RHD development; however, the sample size was too small to make definitive conclusions. Our objective was to determine the prevalence of RHD among HIV-positive children in Uganda. We conducted a prospective, cross-sectional study of HIV-positive children (5-15 years of age) receiving care at the Baylor Uganda HIV Clinic, Kampala, Uganda. A focused echocardiogram and chart review was performed. A sample size of 988 children was needed to provide 80% power to detect a difference in population prevalence between HIV-positive children and the general population, 2.97% [95% confidence interval (CI): 2.70-3.24%], based on previous reports. Screening echocardiography of 993 HIV-positive children found 15 individuals (1.5%; 95% CI: 0.88%-2.54%) with RHD. Of these 15, 2 were classified as definite RHD and 13 as borderline RHD. The majority of children had isolated mitral valve disease (93%). Children found to have RHD were older than those without RHD, 12 versus 10 years of age (P = 0.004). When separated based on geographic location, the prevalence of RHD among HIV-positive children from Kampala was 1.28% (95% CI: 0.63%-2.51%) compared with 2.1% (95% CI: 0.89%-4.89%) in those from outside Kampala. Children living with HIV have a lower prevalence of RHD than the general pediatric population. Further studies are needed to explore this protective association.

The Association of Home Environment and Caregiver Factors With Neurocognitive Function in Pre-school- and School-Aged Perinatally Acquired HIV-Positive Children on cART in South Africa.

Background: Children with perinatally acquired HIV in low resource settings are at risk for neurocognitive impairments not only due to the direct effects of HIV on the brain and in utero ART exposure but also due to factors associated with their environment. Thus, the aim of this study was to examine the association between home environment and caregiver factors and the neurocognitive function of pre-school- and-school-aged HIV-positive South African children from low resource rural communities.Materials and Methods: The Wechsler Preschool and Primary Scale of Intelligence-III was administered to assess the neurocognitive functioning of 152 purposively sampled perinatally acquired HIV-positive children on cART, aged 3 years to 7 years 6 months (mean age 63.13 months). The primary caregivers (n = 152) completed the Home Screening Questionnaire to assess the quality of the home-environment of the children.Results :The results showed that unfavorable environment, caregiver type, and quality of stimulation in the home were negatively associated with the neurocognitive development of perinatally HIV-positive children on cART. Most of the HIV-positive children (n = 95) were under the care of an extended relative. Older HIV-positive boys, reared by biological mothers, who also lived in suboptimal and poor quality home-environments had poorer neurocognitive function when compared to HIV-positive children reared by non-biological (extended relatives) caregivers, [F(2,149) = 14.42, p < 0.001].Conclusion: The child's early home environment is associated with general neurocognitive development, which highlights the need for early psychosocial interventions that can promote better cognitive outcomes among children living with HIV.

Effect of task-shifting HIV testing from laboratory personnel to nurses on paediatric and adolescent HIV testing rate and yield in rural Nigeria: a prospective before-and-after study

Abstract Background Nigeria has the second highest burden of HIV in children younger than 15 years (220 000) and adolescents 10 –19 years (230 000) in the world. Unfortunately, fewer than a quarter of these children and adolescents are identified and given access to treatment. Decentralisation of HIV testing services to high-yield service delivery points can facilitate identification of undiagnosed HIV-positive children and adolescents. However, decentralisation of testing services is still uncommon, partly due to existing health-care professional boundaries. We evaluated the effectiveness of task-shifting HIV testing services from specialised laboratory personnel to nurses to improve HIV case identification in paediatric and adolescent clients. Methods We established a testing point for patients aged 0–19 years in the inpatient ward at a secondary health-care facility in a rural district with high prevalence of HIV in north-central Nigeria. Paediatric nurses were trained by laboratory personnel to provide HIV testing to children and adolescents admitted to the ward. We reviewed the hospital ward admission records and laboratory HIV testing records for patients aged 0–19 years to establish a pre-intervention baseline. Findings In the 3 months before the intervention when HIV testing services were provided only by laboratory personnel, 276 children and adolescents were admitted (mean 92·0 admissions/month), of whom only 22 patients (8%) underwent HIV testing and no positive cases were identified. However, in the 4-month intervention period between April and July, 2018, 179 paediatric or adolescent clients were admitted (44·8 admissions/month), of whom 169 (94%) were tested for HIV by nurses and four HIV-positive children were newly identified (a 2·4% yield). Linkage to care and antiretroviral therapy initiation was achieved for all newly identified children within 24 h of diagnosis. Interpretation Task-shifting of paediatric and adolescent inpatient HIV-testing services to nurses was more effective in HIV case identification than was testing by laboratory personnel. In settings where limited human resources remains a major challenge, implementation and scale-up of task shifting for testing services can significantly improve HIV case identification and, therefore, treatment coverage in children and adolescents. Funding CDC-PEPFAR.

A Phenomenological Account of HIV Disclosure Experiences of Children and Adolescents from Northern and Southern Ghana.

Disclosure of HIV status to infected children, though challenged by caregiver dilemma, remains central in achieving the United Nations Programme on HIV and AIDS (UNAIDS) global goal of 90/90/90. This study explores children’s HIV disclosure experiences across Northern and Southern Ghana. A qualitative interpretative phenomenological design facilitated the recruitment of 30 HIV positive disclosed children and adolescents aged 9–19 years in 12 antiretroviral treatment (ART) centers in Northern and Southern Ghana between January 2017 and June 2018. Data was collected via in-depth interviews. We used phenomenological analysis applying concepts and categories identification, patterns and interconnections searching, mapping, theme building and constant comparative technique to draw conclusions. Disclosure of HIV status to children occurred with little or no preparation. Caregivers intentionally or out of dilemma often prolonged or postponed disclosure to when children aged older. Illness severity and disease progression principally defined the need for disclosure. Children preference for early status disclosure averaged at age 10 was demonstrated despite the initial disclosure experience of shock and disappointment. There was improved medication adherence despite the challenge of limited knowledge about HIV transmission, financial difficulty and food insecurity. Context and culturally adapted pre- and post- disclosure guideline laced with social protection package is needed to support HIV positive children.