HIV-positive Children Research Articles

Effects of undernutrition on survival of human immunodeficiency virus positive children on antiretroviral therapy

BackgroundThe relationship between undernutrition and HIV is bidirectional, ultimately contributing to quality of life and survival of affected individuals. Ethiopia is a sub-Saharan nation influenced by both undernutrition and HIV. In Ethiopia, although individuals are often dually impacted, the effect of undernutrition on the survival of HIV positive children on anti-retroviral therapy (ART) has not been well investigated. Therefore, this study assessed the effect of undernutrition on survival rates of HIV positive children on ART in Amhara Regional State of Ethiopia.MethodsAn institution-based retrospective cohort study was conducted among 390 HIV positive children on ART from the 1st of January, 2012 to the 28th of February, 2017 in Amhara Regional State Referral Hospitals. A simple random sampling technique was used to select the study participants. Data were extracted by reviewing patients’ ART intake and follow-up forms. Data were entered into Epi-Data Version 3.1, and analysis was done using STATA Version 13. The Kaplan-Meier survival curve was used to estimate the cumulative survival time of the sample. Log rank tests were employed to compare the survival time between different categories of explanatory variables. Bivariable and multivariable Cox proportional hazards models were fitted to identify predictors of mortality.ResultsAmong the 390 records included in the final analysis, 9.7% of the individuals died within the follow-up period. In this study, the overall mortality rate was found to be 4.4 per 100 child-years (95% CI: 3.2, 6.0) while undernourished children had a lower survival time than well-nourished children. Low hemoglobin level (AHR: 3.2, 95% CI: 1.4, 7.4), CD4 cell count or percent below the threshold (AHR: 5.2, 95% CI: 1.9, 14.1), severe stunting (AHR: 3.9, 95% CI: 1.7, 9.4), severe wasting (AHR: 3.0, 95% CI: 1.3, 6.9) and advanced disease stage (III and IV) (AHR: 2.6, 95% CI: 1.1, 6.6) were found to be predictors of mortality.ConclusionThere was a high rate of mortality. A significant difference was observed in the survival rate of undernourished and well-nourished children. Low hemoglobin level, CD4 count or percent below the threshold, severe wasting, severe stunting, and advanced disease stage were found to be predictors of mortality.

Plasmodium falciparum diagnostic tools in HIV-positive under-5-year-olds in two ART clinics in Ghana: are there missed infections?

BackgroundPlasmodium falciparum, the most dominant species in sub-Saharan Africa, causes the most severe clinical malaria manifestations. In resource-limited Ghana, where malaria and HIV geographically overlap, histidine-rich protein 2 (HRP2)-based rapid diagnostic test (RDT) is a faster, easier and cheaper alternative to clinical gold standard light microscopy. However, mutations in parasite hrp2 gene may result in missed infections, which have severe implications for malaria control.MethodsThe performance of a common HRP2-based RDT and expert light microscopy in HIV-positive and HIV-negative children under 5 years old was compared with PCR as laboratory gold standard. Finger-prick capillary blood was tested with First Response® Malaria Ag P. falciparum (HRP2). Giemsa-stained thick and thin blood films were examined with ≥ 200 high power fields and parasites counted per 200 white blood cells. Nested PCR species identification of P. falciparum was performed and resolved on agarose gel. False negatives from RDT were further tested for deleted pfhrp2/3 and flanking genes, using PCR. The study was performed in two anti-retroviral therapy clinics in Accra and Atibie.ResultsOut of 401 participants enrolled, 150 were HIV positive and 251 HIV negative. Malaria was more prevalent in children without HIV. Microscopy had a higher sensitivity [100% (99–100)] than RDT [83% (53.5–100)]. Parasites with pfhrp2/3 deletions contributed to missed infections from RDT false negatives.ConclusionCirculation of malaria parasites with pfrhp2/3 deletions in this population played a role in missed infections with RDT. This ought to be addressed if further strides in malaria control are to be made.

Characterization and Protective Efficacy of Type III Secretion Proteins as a Broadly Protective Subunit Vaccine against Salmonella enterica Serotypes.

Nontyphoidal Salmonella enterica serotypes (NTS) are the leading cause of hospitalization and death due to foodborne illnesses. NTS are the costliest of the foodborne pathogens and cause ∼$4 billion annually in health care costs. In Africa, new invasive NTS are the leading cause of bacteremia, especially in HIV-positive children and adults. Current vaccines against S. enterica are not broadly protective and most are directed at the typhoid-causing serotypes, not the NTS. All S. enterica strains require two type III secretion systems (T3SS) for virulence. The T3SS needle tip protein and the first translocator are localized to the T3SS needle tip and are required for pathogenesis of S. enterica Collectively they are 95 to 98% conserved at the amino acid sequence level among all S. enterica strains. The Salmonella pathogenicity island 1 or 2 tip and first translocator proteins were genetically fused to produce the S1 and S2 fusion proteins, respectively, as potential vaccine candidates. S1 and S2 were then characterized using spectroscopic techniques to understand their structural and biophysical properties. Formulated at the proper pH, S1, S2, or S1 plus S2 (S1S2), admixed with adjuvant, was used to immunize mice followed by a lethal challenge with S. enterica serotype Typhimurium or S. enterica serotype Enteritidis. The S1S2 formulation provided the highest protective efficacy, thus demonstrating that an S1S2 subunit vaccine can provide broad, serotype-independent protection, possibly against all S. enterica serotypes. Such a finding would be transformative in improving human health.

Human immunodeficiency virus status disclosure and education for children and adolescents in Papua New Guinea

How to provide human immunodeficiency virus (HIV) disclosure and awareness for children and young people has not been studied in Papua New Guinea or Pacific Island countries. We aimed to determine the current practices of HIV disclosure and evaluate whether an incremental disclosure education model, as recommended by World Health Organization (WHO), would increase children's knowledge about their condition and improve adherence to antiretroviral therapy (ART). We enrolled HIV-infected children on ART whose parents consented, and we identified whether they were aware that they were HIV positive or not. An incremental education model was used to teach the children about their illness and to disclose their HIV status if that was the parents' wishes. Knowledge of HIV and adherence to ART before and following education sessions was assessed. A total of 138 children HIV-positive children were recruited. Only 7% had previously been made aware of their HIV test results; the mean disclosure age was 12.7 years. By 10 years of age, 25 of 34 participants (74%) had not been told they had HIV. The common reasons caregivers gave for not disclosing were that the child was too young and the potential psychosocial impacts on the child and the family. Using an education model of HIV disclosure, children's knowledge of HIV increased significantly, and ART adherence, which was good at 95%, increased to 99% an average of 9 months after education. There is a low rate of disclosure for HIV-infected children in Papua New Guinea. This study underlines the importance and value of incorporating age-appropriate HIV education within HIV services.

Factors associated with abnormal glomerular filtration rate among HIV-positive children at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Background: Renal disease is commonly encountered in patients with HIV infection. The estimated glomerular filtration rate (eGFR) provides a good assessment of the renal function and is widely used in screening populations that are at risk of renal dysfunction. We determined the prevalence of abnormal eGFR among HIV-positive children and factors associated with it. Methods: In a cross-sectional study, children aged 15 years and below were recruited through systematic random sampling from the Paediatrics Infectious Disease Clinic of the University of Maiduguri Teaching Hospital until the desired sample size of 250 was reached. Clinical and laboratory information was obtained from the patient records and used for clinical staging and immunological classification. Serum creatinine was measured using Jaffe’s reaction and eGFR calculated using the Schwartz formula. The data obtained were analysed using SPSS version 16. Results: A total of 157 (62.8%) children were on antiretroviral therapy (HAART) for periods ranging from 1 to 168 months (mean duration 66.1 ± 46.5 months). Ninety-three (37.2%) children had advanced disease representing WHO clinical stages 3 and 4, whereas 103 (41.2%) had advanced or severe immunosuppression. The mean eGFR of the study population was 102 ± 41 mL/min/1.73 m2. Fifty-two children (20.1%) had low eGFR ( 2 SD above the mean eGFR for age and sex). A total of 23 (9.2%) children had moderate to severe renal impairment, defined as eGFR <60 mL/min/1.73 m2. Age, sex, socio-economic status, mode of transmission as well as history of HAART usage were not significantly associated with abnormal eGFR. However, relatively shorter duration of treatment with HAART, as well as advanced clinical or immunological stage were all significantly associated with abnormal eGFR. Conclusion: Renal dysfunction is common among children with HIV disease in Maiduguri with over a third of those affected having moderate to severe renal dysfunction. Abnormal renal function is more frequent among children with advanced clinical and immunological disease. We recommend the regular determination of eGFR and early initiation of HAART in all children with HIV disease.

Neurocognitive functioning of HIV positive children attending the comprehensive care clinic at Kenyatta national hospital: exploring neurocognitive deficits and psychosocial risk factors

ABSTRACTChildren and adolescents are affected in different ways by HIV/AIDS. Neurocognitive deficits are one of the most significant long term effects on HIV infected children and adolescents. Several factors are thought to influence cognitive outcomes and this include immune status, Highly Active Antiretroviral Therapy (HAART), education and social support. The aim of the study was to assess the neurocognitive function of HIV infected children and adolescents and correlate it with psychosocial factors. A cross sectional study was carried out involving a sample of 90 children living with HIV between 8 and 15 years (M = 11.38, SD = 2.06) attending Comprehensive Care Clinic (CCC) at Kenyatta National Hospital (KNH). Samples were selected by using purposive sample technique. Kaufman Assessment Battery for Children-Second Edition was used to assess cognitive function and psychosocial issues were assessed using HEADS-ED. Data was analyzed using SPSS v23 and independent T-tests, Pearson’s correlation and linear regression were used. The prevalence of neurocognitive deficits among HIV positive children attending CCC at KNH was 60% with neurocognitive performance of 54 children being at least 2SD below the mean based on the KABC-II scores. There was no significant correlation between mental processing index and CD4 count (Pearson’s rho = −0.01, p = 0.39). There was no significant association between Mental Processing Index and viral load (p = 0.056) and early ARV initiation (0.27). Using the HEADS-ED, risks factors related to education (β = −5.67, p = 0.02) and activities and peer support (β = −9.1, p = 0.002) were significantly associated with poor neurocognitive performance. Neurocognitive deficits are prevalent among HIV positive children attending CCC-KNH. This extent of the deficits was not associated with low CD4 count, high viral load or early initiation in HIV care. However, poor school performance and problem with peers was associated with poor neurocognitive performance.

Antiretroviral therapy clinic attendance among children aged 0-14 years in Kahama district, Tanzania: a cross-sectional study

Background: Efforts made to scale up care and treatment for HIV in Tanzania have started to pay off. The number of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) has massively increased owing to an increase in investment made. However, this is not reflected in all populations, especially children living with HIV. This study, therefore, aims to determine the magnitude and factors associated with ART uptake among children living with HIV in Kahama district, Tanzania. Methods: This cross-sectional study was conducted among pairs of children aged 0-14 years and their caregivers. A total of 423 randomly selected caregivers of HIV-positive children were interviewed using a structured questionnaire. The outcome variable was ART uptake while independent variables constituted of socio-demographic, health facility, and systemic factors. Results : A total of 132 (31%) of all caregivers reported to have missed at least one clinic visit for their children during a period of three months before the survey. Of them, one in four missed at least two clinics. Caregivers cited factors such as lack of transport fare and distance to the health facility as barriers to attend the planned clinics. After adjusting for the important confounders and other covariates, factors associated with ART uptake were being divorced/widowed (AOR= 0.57, 95% CI; 0.33-0.97) and having primary education or more (AOR 0.30, 95% CI 0.11-0, 82). Conclusion: One in every three HIV-positive children miss their scheduled routine ART clinics in Kahama, Shinyanga. Tailored interventions should target caregivers of such children who are divorced or widowed and those with low or no education while addressing distance and transportation challenges in this and other areas with similar contexts.

Attrition among HIV positive children enrolled under integrated HIV care programme in Myanmar: 12 years cohort analysis

ABSTRACTBackground: In Myanmar, HIV seropositive children are being enrolled in an integrated HIV care (IHC) Program for HIV treatment and care since 2005.Objectives: To assess the: (a) attrition (death or loss-to-follow-up) rates among children (aged ≥ 18 months to < 15 years) enrolled into the programme before and after initiation of anti-retroviral therapy (ART) (pre-ART and ART periods); (b) demographic and clinical factors associated with attrition during these two periods.Methods: Children enrolled in IHC Programme and their status (death, lost to follow-up, regular follow-up or transferred out) was assessed as on 30 June 2017. Attrition rates (per 100 person-years) at pre – ART and ART periods were calculated and the association between demographic and clinical characteristics with attrition was assessed using Cox proportional hazards model.Results: Among 2,736 children enrolled, pre-ART attrition rate was 19 per 100 person-years of follow-up (95% CI: 17–21) and ART attrition rate was 4 per 100 person-years of follow-up (95% CI: 3–4) with higher levels during the initial few months of enrolment. The 36-month retention rates during pre-ART period was 75% (95% CI: 72–78) and during ART period was 87% (95% CI: 86–88). The children ‘at enrolment’ with relatively lower levels of haemoglobin, immune deficiency, underweight for age, higher WHO clinical stages, presence of hepatitis B infection had higher hazards of attrition in both periods.Conclusion: The attrition rates are high particularly among children with relatively poorer clinical, nutritional profiles at enrolment. The study suggests the urgent need for improving adherence counselling especially during the initial few months of enrolment and early ART initiation.

HIV Encephalopathy (HIVE) in Children at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria

Background: HIV encephalopathy (HIVE) is associated with cognitive impairment in children with HIV infection, early diagnosis and initiation of HAART may reduce the morbidity associated with HIVE. Objective: To determine the prevalence of HIVE and associated comorbiditiesin children at the UPTH. Methodology: This was a retrospective study carried out from January to June 2017. The case notes of all HIV positive children presenting to the Paediatric Department of the University of Port Harcourt Teaching Hospital (UPTH) were studied. Children who met the diagnostic criteria for HIVE according to the Centre for Disease Control (CDC) definition were selected. The socio-demographic characteristics of the patients, mode of HIV transmission, CD4 count and associated comorbidities in these children were retrieved from the case notes. Obtained data was analyzed using Epi Info version 7.2. Comparisms of subgroups was carried out using the chi square test while statistical significance at 95% confidence interval was p value p = 0.187). Thirty (85.7%) of the patients with HIVE were on HAART at diagnosis. The mean age at diagnosis of HIV was 3.2 ± 3.1 years and the mean age at diagnosis of HIV encephalopathy was 3.4 ± 3.2 years. The documented route of transmission for all the subjects was mother-to-child-transmission (MTCT). Seventy five percent of the children were breastfed from birth and at 6 months all the mothers had discontinued breastfeeding. The mean CD4 count was 1053 ± 630 cells/ml. Tuberculosis was the most prevalent co-morbidity occurring among the patients. Conclusion: The prevalence of HIVE in children at the UPTH is high and Tuberculosis is the commonest comorbidity. Early infant diagnosis, use of modern diagnostic tool and early initiation of HAART are advocated to reduce its associated morbidity.

Skin Manifestations of HIV Infection in Children in Pediatric Services of Conakry University Hospital (Guinea)

Introduction: Dermatological manifestations during HIV infection play a diagnostic and prognostic role. They are observed in 83% - 98% of patients at the late stage of AIDS and 58% - 75% at an early stage of AIDS. The objective of this study was to determine the prevalence of skin diseases in HIV in children, describes the demographic profile and identify key dermatoses. Material and methods: This was a prospective study of descriptive kind conducted from August 25, 2009 to February 25, 2010. It involved children infected with HIV followed in pediatric services at the University Hospital of Conakry. All children were examined by an experienced dermatologist. The diagnosis of dermatosis was made according to the clinical signs. The stages of HIV infection were determined according to the WHO classification. Each child received retroviral serology rapid tests according to national algorithm. Results: Among 119 HIV-positive children 65 showed mucocutaneous manifestations, there are 34 girls and 31 boys, all HIV-1 infected with 66.16% in stage III disease. The average age was 7 years, ranging from 11 months to 15 years. 66.15% of the children were from married mothers and more than half of the mothers were illiterate. They were all positive for HIV1. Oral candidiasis (38.46%), prurigo (29.23%) and molluscum contagiosum (7.69%) were the most common skin diseases; 52.31% had at least two associated dermatoses. The candidiasis-prurigo combination (26.47%) was the most common. Dermatosis was often associated with other conditions: malaria (30.76%), pulmonary tuberculosis (25.61%) and malnutrition (12.30%). Discussion: With 65 cases diagnosed in six months our study shows that skin diseases are common in HIV among children in Guinea. The prevalence and socio-demographic characteristics are close to those reported by sub saharian and North African authors. A special feature of the study is that most mothers are illiterate and are infected with HIV, which would have favored the contamination of these children. Conclusion: In Sub-Saharan Africa where the rate of pediatric HIV infection is increasing, it is important to identify the mucocutaneous manifestations for optimal care.

Caregivers' perspectives on disclosure, care, and treatment among pediatric HIV/AIDS patients in South India: A qualitative study.

Background:Rollout of antiretroviral therapy (ART) has helped to achieve the increased life span among pediatric HIV patients. The psychosocial aspects of parents or caregivers can affect the treatment adherence in children and the disease outcome.Aims and Objectives:This study aims at understanding the perspectives on disclosure of HIV status, stigma, antiretroviral treatment, and compliance among caregivers of children attending ART clinic in South India and to explore the barriers to treatment-seeking behavior.Materials and Methods:This facility-based qualitative study was carried out among caregivers of pediatric HIV patients <15 years of age. In-depth interview was conducted on caregivers after informed consent in the absence of the child, focusing on stigma, disclosure of HIV status to children, adherence, and coping strategies followed by the parents. The complete interviews were transcribed in English, and content analysis was done to identify the emergence of codes. Interview was conducted among mothers of affected child. The disease status of the children was known only to the parents and not to the children themselves (excepting one) or siblings. Parents intended to keep it confidential for the affected children as long as possible. Nevertheless, to maintain adherence and to prevent disclosure of HIV status, mothers traveled to this ART center from very far places, medical records were hidden, and tablets were removed from the strips and said to be medicines for energy and protection.Conclusion:Mothers of HIV-positive children faced many difficulties to prevent the disclosure of the diagnosis from the affected children and others, which is not very conducive to adherence to the ART regimen. Effective disclosure strategies to manage this emotionally vulnerable group are an urgent need.

Pattern of paediatric HIV status disclosure in coastal Karnataka.

Background & objectives:Karnataka is a high HIV prevalent State in India. Although benefits have been shown by disclosing the HIV status to the child, information regarding HIV status disclosure in Karnataka is limited. Hence, this study was conducted to estimate the proportion of children who had been disclosed of their HIV status and its pattern among those who visited the district antiretroviral therapy (ART) centre in coastal Karnataka.Methods:A cross-sectional study was conducted in an ART centre in a district hospital in coastal Karnataka between October 2014 and July 2015. Caregivers of paediatric HIV patients were approached and willing participants were administered a pre-formed, pre-tested semi-structured questionnaire developed for the study.Results:A total of 185 caregivers of the HIV-positive children were interviewed. Mean age of the children was 11±4 years. Only 107 (57.8%) children were aware of their HIV status. Of these, 95 were disclosed fully. Counsellors in rehabilitation centres were the most probable person to disclose and planned events. Children were told of their HIV status for their knowledge and were more likely to be disclosed if they were around 11-15 yr of age and staying in rehabilitation centres.Interpretation & conclusions:Older children were more likely to be disclosed of their HIV status by counsellors. Steps need to be taken to counsel and encourage caregivers to fully disclose the HIV status to the children at least when they attain the age more than 11 years.

A study of neuropsychological profile of human immunodeficiency virus-positive children and adolescents on antiretroviral therapy.

Aims:The aim is to study the neuropsychological and functional profile of children and adolescents with human immunodeficiency virus (HIV) infection on antiretroviral therapy (ART) and the association between the neuropsychological status and medical illness variables, treatment variables, and functional status in the cases of the sample and compare with normal controls.Materials and Methods:Forty-two HIV-positive children and adolescents on ART were evaluated and compared with 40 matched controls not known to be HIV-positive. The tools used were the Wechsler Intelligence Scale for Children-III R for neuropsychological evaluation, the Brief Impairment Scale to assess functional impairment, and a semi-structured questionnaire to obtain other relevant details.Results:There were significant differences between the verbal, performance intelligence quotients (IQs), global IQ score, and several individual subtests between cases and controls. The HIV group was also found to have a significant functional impairment.Conclusion:Our findings show that HIV infection is associated with significant cognitive and functional impairment. The role of ART in these impairments requires further study. Such understanding can help to introduce wholesome and relatively safer management strategies for youngsters with HIV infection and improve their quality of life.

Craniofacial morphology of HIV-positive children and adolescents undergoing antiretroviral therapy: A pilot study.

In this study, we aimed to analyze craniofacial morphology by assessing the skeletal cephalometric profiles of HIV-positive patients receiving antiretroviral therapy. For this study, 21 HIV-positive patients aged between 6 and 17years (study group) were selected and compared with 21 normoreactive patients (control group), paired by sex and age. The patients were also divided into 3 age ranges (6-8, 9-12, and 13-17years) considering the pubertal growth spurt as the central event. Eighteen (linear and angular) measurements were traced on teleradiographs by using 2 methodologies. The mean values of each measurement were compared between the study and control groups by age range. The majority of the measurements checked in the HIV-positive children and adolescents for the 13-to-17year age range were diminished, but not enough to generate a statistically significant difference in craniofacial growth. Statistically significant differences (P<0.05) were found only in the inclination of the palatal plane (6-8years) and the position of the maxilla in the anteroposterior direction (13-17years). These results led us to conclude that some cephalometric measurements of HIV-positive children and adolescents may be similar to those of normoreactive subjects.

Hope for the Future But Fear the Risk of Stigma: Ethiopian Family Caregivers’ Lived Experience of Caring for Their HIV Positive Child Two Years After Starting Antiretroviral Treatment

ABSTRACTFamily caregivers are believed to be the primary source of support for HIV-affected children. There is limited evidence about practices of support for caregivers, to strengthen them and to enhance the welfare of HIV positive children, especially in African settings. Our aim was therefore to illuminate caregivers’ lived experiences of caring for a child in Ethiopia 2 years after the child was enrolled in antiretroviral therapy. Qualitative interviews with 18 family caregivers of 18 children were performed and analyzed using an inductive design with a hermeneutic phenomenological approach. The family caregivers’ lived experience was shown in two main themes comprising “lifelong medication gives hope for the future” and “support challenged by the fear of stigma.” The family caregivers experienced hope and dreams for the future as they saw their child as healthy and they had regained normality in life after the child’s diagnosis. The caregivers still feared the disclosure of the child’s diagnosis, which gave rise to conflicts with the child, the family, and society. Good quality support from the healthcare staff lightened their burdens. Further studies are recommended on the strategies of stigma reduction and developing need-specific modalities to support caregivers in the community.

The PREVENT study to evaluate the effectiveness and acceptability of a community-based intervention to prevent childhood tuberculosis in Lesotho: study protocol for a cluster randomized controlled trial

BackgroundEffective, evidence-based interventions to prevent childhood tuberculosis (TB) in high TB/HIV-burden, resource-limited settings are urgently needed. There is limited implementation of evidence-based contact management strategies, including isoniazid preventive therapy (IPT), for child contacts of TB cases in Lesotho.Methods/designThis mixed-methods implementation science study utilizes a two-arm cluster-randomized trial design with randomization at the health facility level. The study aims to evaluate the effectiveness and acceptability of a combination community-based intervention (CBI) versus standard of care (SOC) for the management of child TB contacts. The study includes three phases: (I) exploratory phase; (II) intervention implementation and testing phase; (III) post-intervention explanatory phase. Healthcare provider interviews to inform intervention refinement (phase I) were completed in December 2015. In phase II, 10 health facilities were randomized to deliver the CBI or SOC, with stratification by facility type (i.e., hospital vs. health center). CBI holistically addresses the complex provider-related, patient-related, and caregiver-related barriers to prevention of childhood TB through nurse training and mentorship; health education for caregivers and patients by village health workers; adherence support using text messaging and village health workers; and multidisciplinary team meetings, where programmatic data are reviewed and challenges and solutions are discussed. SOC sites follow country guidelines for child TB contact management. Routine TB program data will be abstracted for all adult TB cases newly registered during the study period and their child contacts from TB registers and cards. The anticipated sample size is 1080 child contacts. Primary outcomes are yield (number) of child contacts, including children < 5 years of age and HIV-positive children < 15 years of age; IPT initiation; and IPT completion. Secondary outcomes include HIV testing; yield of active prevalent TB among child contacts; and acceptability and utilization of CBI components. Intervention implementation began in February 2016 and is ongoing. Post-intervention interviews with healthcare providers and caregivers (phase III) commenced in February 2017.DiscussionThe PREVENT study tests the effectiveness and acceptability of a novel combination CBI for child TB contact management in Lesotho. If effective, CBI will have important implications for addressing childhood TB in Lesotho and elsewhere.Trial registrationClinicalTrials.gov, NCT02662829. Registered on 15 January 2016.

Tuberculin skin test conversion and primary progressive tuberculosis disease in the first 5 years of life: a birth cohort study from Cape Town, South Africa

SummaryBackgroundTuberculosis is a leading cause of global childhood mortality. However, the epidemiology and burden of tuberculosis in infancy is not well understood. We aimed to investigate tuberculin skin test conversion and tuberculosis in the Drakenstein Child Health study, a South African birth cohort in a community in which tuberculosis incidence is hyperendemic.MethodsIn this prospective birth cohort study, we enrolled pregnant women older than 18 years who were between 20 and 28 weeks' gestation and who were attending antenatal care in a peri-urban, impoverished South African setting. We followed up their children for tuberculosis from birth until April 1, 2017, or age 5 years. All children received BCG vaccination at birth. Tuberculin skin tests were administered to children at 6, 12, 24, 36, 48, and 60 months of age, and at the time of a lower respiratory tract infection. An induration reaction of 10 mm or more was considered to be a tuberculin skin test conversion. To prevent boosting, we censored children with a reactive, negative tuberculin skin test.FindingsAmong 915 mother–child pairs (201 [22%] HIV-positive mothers and two [<1%] HIV-positive children), 147 (16%) children had tuberculin skin test conversion, with increasing cumulative hazard with age (0·08 at 6 months, 0·17 at 12 months, 0·22 at 24 months, and 0·37 at age 36 months). For every 100 child-years, the incidence was 11·8 (95% CI 10·0–13·8) for tuberculin skin test conversion, 2·9 (2·4–3·7) for all diagnosed tuberculosis, and 0·7 (0·4–1·0) for microbiologically confirmed tuberculosis. Isoniazid preventive therapy was effective in averting disease progression (adjusted hazard ratio 0·22, 95% CI 0·08–0·63; p<0·0001). Children with a lower respiratory tract infection were significantly more likely to also have tuberculosis than were those without one (2·27, 1·42–3·62; p<0·0001).InterpretationGreater focus should be placed on the first years of life as a period of high burden of transmission and clinical expression of tuberculosis infection and disease. Multifaceted interventions, such as isoniazid preventive therapy and tuberculosis screening of infants with LRTIs, beginning early in life, are needed in high-burden settings.FundingBill & Melinda Gates Foundation, Medical Research Council South Africa, and National Research Foundation South Africa.

Over-age and underserved: a case control study of HIV-affected children and education in Rwanda

ABSTRACTChildren living with and affected by HIV are at risk of poverty and mental health problems that can interfere with educational attainment. This review is a secondary analysis of educational attainment within a case-controlled study of children 10–17 years of age who were HIV-positive, HIV-affected by caregiver HIV status or by HIV in their family and HIV-unaffected in rural Rwanda. We evaluated caregiver and child-reported HIV-related stigma, anxiety/depression, conduct problems and social support and any likely associations with children being overage for their current grade in school. Overall, 90.4% of children were enrolled in school; however, 83.8% were overage for their current grade, with higher rates of overage for grade among HIV-positive and HIV-affected children. Interventions and policies that recognize and promote social support within education to address challenges of conduct problems among youth may help counteract the high rates of grade repetition among children in rural Rwanda.

Vaccine-related poliovirus shedding in trivalent polio vaccine and human immunodeficiency virus status: analysis from under five children

BackgroundPoliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. The causative agent is one of the three serotypes of poliovirus (serotypes 1, 2, 3) that differ slightly in capsid protein. Prolonged vaccine-related poliovirus shedding in human immunodeficiency virus (HIV) positive individuals has been linked to possible reservoir for reintroduction of polioviruses after eradication. The study therefore aimed at estimating the duration for vaccine-related poliovirus shedding among potentially and HIV-infected persons.MethodsPoliovirus excretion was studied following vaccination of children aged ≤ 59 month per human immunodeficiency virus status after national immunization days. Their medical records were reviewed to identify the child’s HIV status, demographic and immunization data. Sequential stool samples were collected at site 2nd, 4th and 8th week after trivalent oral poliovirus vaccine (tOPV) was administered. To isolate suspected polioviruses and non-polio enteroviruses, characterize poliovirus subtypes by intratypic differentiation and Sabin vaccine derived poliovirus, real time polymerase chain reaction was applied. Shedding for ≥ 24 weeks was defined as long-term persistence.ResultsThe mean age of the study population was 28.6 months, while the median age was 24 months. Of the children recruited, majority were in the 25–48 months (n = 12; 46.2%) age category. All the HIV-positive children (n = 10) had mild symptomatic HIV status and did shed vaccine-related polioviruses between weeks 2 and 4 respectively. No participant shed polioviruses for ≥ 6 weeks.ConclusionsIt was evident mildly symptomatic HIV+ children sustain the capacity to clear vaccine-related poliovirus. The oral poliovirus vaccine-2 (Sabin like) that was detected in one HIV-infected child’s stool 6 weeks after the national immunization days was predominantly non revertant. There was no evident prolonged poliovirus shedding among the participants enlisted in the present study. High powered studies are desired to further corroborate these findings.

Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study.

Background & aimsEmphasis on adolescent HIV has increased worldwide as antiretroviral treatment has greatly extended life expectancies of HIV-positive children. Few evidence-based guidelines exist on the optimal time to disclose to an adolescent living with HIV (ALHIV); little is known about the medical effects of disclosure. This study looked to determine whether disclosure is associated with improved medical outcomes in ALHIV. Prior work has tended to be qualitative, cross-sectional, and with an emphasis on psychosocial outcomes. This paper addresses the adolescent cohort retrospectively (longitudinally), building upon what is already known about disclosure.MethodsRetrospective, longitudinal clinical record reviews of ALHIV seen at Kericho District Hospital between April 2004 and November 2012 were performed. Patient demographics and clinical outcomes were systematically extracted. The student’s t-test was used to calculate changes in mean CD4 count, antiretroviral therapy (ART), and cotrimoxazole adherence pre- vs. post-disclosure. Linear regression modelling assessed for trends in those clinical outcomes associated with age of disclosure.ResultsNinety-six ALHIV (54 female, 42 male) were included; most (73%) entered care through the outpatient department. Nearly half were cared for by parents, and 20% experienced a change in their primary caregiver. The mean time in the study was 2.47 years; mean number of visits 10.97 per patient over the mean time in the study. Mean disclosure age was 12.34 years. An increase in mean ART adherence percentage was found with disclosure (0.802 vs. 0.917; p = 0.0015). Younger disclosure age was associated with significantly higher mean CD4 counts over the course of the study (p = 0.001), and a nonsignificant trend toward a higher mean ART adherence percentage (p = 0.055).ConclusionART adherence and improved immunologic status are both associated with disclosure of HIV infection to adolescent patients. Disclosure of an HIV diagnosis to an adolescent is an important means to improve HIV care.