HIV-positive Children Research Articles

Predictors of survival among HIV-positive children on ART in Swaziland

The objective of the study was to determine predictors of survival among HIV-positive children (<15 years) in Swaziland. A retrospective cohort analysis of medical records for 4 167 children living with HIV who were initiated on antiretroviral therapy (ART) between 2004 and 2008, and followed up until 2014 was conducted in clinical settings at 36 health facilities. The Kaplan Meier Estimator, signed-ranks test, and the Cox proportional hazards regression model were applied to determine survival probabilities, significant difference among stratified survival functions and adjusted hazard ratios respectively. The results reveal that the median survival time for children was 78 months (95% CI: 77–79). Children who were initiated early on ART had higher survival probability over time (HR: 0.35 [95% CI: 0.21–0.57], p < 0.001) compared to those whose ART initiation was delayed. Children within the age group of <1 years had higher hazard (HR = 1.55 [95% CI: 1.16–2.08], p < 0.001) of death than children within the age group of 1–14 years. Children who were nourished had 88% lower hazard of death (HR: 0.12 [95% CI: 0.07–0.19], p < 0.001) than severely malnourished children. The study demonstrates that ART paediatric services are effective in increasing survival among HIV infected children and early initiated children have high survival probability. Active tuberculosis (TB), malnutrition, and delayed ART initiation remain predictors of poor survival among children living with HIV.

A qualitative analysis of the barriers to antiretroviral therapy initiation among children 2 to 18 months of age in Swaziland

HIV/AIDS remains one of the leading causes of death among children under 5 years old in Swaziland. Although studies have shown that early initiation of infants and children diagnosed with HIV on antiretroviral therapy (ART) significantly reduces mortality, many children do not initiate ART until the later stages of disease. This study was designed to collect qualitative data from mothers and caregivers of HIV-positive children to identify the barriers to ART initiation. Focus group discussion (FGD) sessions were conducted in siSwati between July and September 2014 among caregivers of aged children 2–18 months in Swaziland who did or did not initiate ART between January 2011 and December 2012 after HIV DNA PCR-positive diagnosis of the infants. Denial, guilt, lack of knowledge, tuberculosis (TB)/HIV co-infection, HIV-related stigma, lack of money, and distance to clinics were reported by the participants as barriers to ART initiation. The findings further revealed that non-initiation on ART was not linked to a negative perception of the treatment. Findings suggest a need to improve sensitivity among healthcare workers as well as education and counselling services that will facilitate the ART initiation process.

Isoniazid for preventing tuberculosis in HIV-infected children.

BackgroundTuberculosis (TB) is an important cause of illness and death in HIV‐positive children living in areas of high TB prevalence. We know that isoniazid prophylaxis prevents TB in HIV‐negative children following TB exposure, but there is uncertainty related to its role in TB preventive treatment in HIV‐positive children.ObjectivesTo summarise the effects of TB preventive treatment versus placebo in HIV‐positive children with no known TB contact on active TB, death, and reported adverse events.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, Embase and two trial registers up to February 2017.Selection criteriaWe included trials of HIV‐positive children with and without known TB exposure, randomized to receive TB preventive treatment or placebo.Data collection and analysisTwo review authors independently used the study selection criteria, assessed risk of bias, and extracted data. We assessed effects using risk, incidence rate and hazard ratios and assessed the certainty of evidence using GRADE.Main resultsWe included three trials, involving 991 participants, below the age of 13 years, from South Africa and Botswana. Children were randomized to isoniazid prophylaxis or placebo, given daily or three times weekly. The median length of follow‐up ranged from 5.7 to 34 months; some were on antiretroviral therapy (ART).In HIV‐positive children not on ART, isoniazid prophylaxis may reduce the risk of active TB (hazard ratio (HR) 0.31, 95% confidence interval (CI) 0.11 to 0.87; 1 trial, 240 participants, low certainty evidence), and death (HR 0.46, 95% CI 0.22 to 0.95; 1 trial, 240 participants, low certainty evidence). One trial (182 participants) reported number of children with laboratory adverse events, which was similar between the isoniazid prophylaxis and placebo groups. No clinical adverse events were reported.In HIV‐positive children on ART, we do not know if isoniazid prophylaxis reduces the risk of active TB (risk ratio (RR) 0.76, 95% CI 0.50 to 1.14; 3 trials, 737 participants, very low certainty evidence) or death (RR 1.45, 95% CI 0.78 to 2.72; 3 trials, 737 participants, very low certainty evidence). Two trials (714 participants) reported number of clinical adverse events and three trials (795 participants) reported number of laboratory adverse events; for both categories, the number of adverse events were similar between the isoniazid prophylaxis and placebo groups.Authors' conclusionsIsoniazid prophylaxis given to all children diagnosed with HIV may reduce the risk of active TB and death in HIV‐positive children not on ART in studies from Africa. For children on ART, no clear benefit was detected. .12 April 2019Up to dateAll studies incorporated from most recent searchAll eligible published studies found in the last search (17 Feb, 2017) were included

A study of clinico-immunological response to art in HIV infected children in western Rajasthan

Background: Study of clinico immunological response to antiretroviral drugs in HIV infected children.Methods: 50 HIV positive children after immunological categorization put on first line pediatric ART treatment according to pediatric ART NACO guideline, side effect, clinical response (in the form of change of WHO clinical staging), and immunological response (in the form of change of CD4 count, and immunological staging) were noted on follow up study.Results: The Correlation between WHO clinical staging and immunological staging was poor so initiating anti retro viral treatment should be preferably based on CD4 count. Children who were initiated on ART have a significant improvement in both WHO clinical and immunological staging at the six and twelve months follow up and ART found to be well tolerated.Conclusions: Significant clinical and immunological improvement occur in the children who were put on ART based on CD4 counts provided if the adherence level is very good.

HIV status and hearing loss among children between 6 and 12 years of age at a large urban health facility in south western Uganda

IntroductionPediatric HIV infection and treatment may increase the risk for hearing loss (HL), both sensorineural (SNHL) and conductive hearing loss (CHL). There is limited data on this subject, especially from sub Saharan Africa. The aim of this study was therefore to compare the prevalence of hearing loss among HIV positive and negative children, to determine the types of hearing loss and whether Nevirapine (NVP) based antiretroviral therapy (ART) is associated with HL. MethodsWe conducted a cross sectional study at two tertiary health facilities in south western Uganda. We consecutively enrolled 79 HIV negative and 148 HIV positive children aged between 6 and 12 years. Inclusion criteria were completion of written consent, ability to follow instructions to perform an audiogram and absence of congenital HL. We conducted hearing screening using the iPad Shoebox® audiometer, and confirmatory assessments were conducted using pure tone audiometry. Hearing was classified as either normal hearing, CHL, SNHL or mixed. ResultsOf the 227 children enrolled, 115 (50.7%) were female. The mean age was 9.2 years (median = 9). Based on self-report, frequency of HL among HIV positive children was 6.8% and 20.3% among HIV negative children (p=<0.01). Using objective measures, prevalence of HL among the HIV positive children was 8.8% compared to 10.1% among the HIV negative children (p = 0.74). CHL was generally more frequent than SNHL but SNHL occurred more frequently among HIV positive (7.4%) compared to HIV negative children (3.8%). No association was found between NVP based ART and HL (p = 0.41). Logistic regression showed that older age of the child (p = 0.01), previous ear infection (p=<0.01), tuberculosis (TB) treatment (p=<0.01) and long term duration on ART (p=<0.01) were significantly associated with HL. Age (p = 0.02), previous ear infection (p = 0.01) and TB treatment (p = 0.005) remained significant in the multiple regression model. ConclusionPrevalence of HL is similar among HIV positive and negative children. Older age of the child, previous ear infection, use of TB drugs and long duration on ART among the HIV positive children increase the odds of having hearing loss among children. However, use of NVP was not associated with HL.

Enrolling HIV-positive adolescents in mental health research: A case study reflecting on legal and ethical complexities.

Adolescents living with HIV are an emerging group in the global HIV/AIDS epidemic. Mental health in this population affects HIV care, treatment, consequential morbidity and secondary transmission. There is a paucity of research regarding these youth in South Africa (SA), partly because section 71 of the National Health Act of 2003 (NHA) requires parental or guardian's consent. To explore legal and ethical issues related to conducting adolescent mental health research in SA. After obtaining a High Court order permitting research on minors aged &lt;18 years without prior parental or guardian's consent, we used qualitative and quantitative methods to interview adolescents in five clinics serving HIV-positive adolescents in Johannesburg. Our study enrolled 343 participants; 74% were orphaned and did not have legal guardians, 27% were symptomatic for depression, anxiety or post-traumatic stress disorder, 24% were suicidal, and almost 90% did not feel that they belonged in the family with which they lived. Without court intervention, most of the participants could not have participated in this research because parental consent was impossible to obtain. This case study argues for exceptions to the parental consent requirement, which excludes orphaned and vulnerable children and youth from research. Recommendations are made to promote ethical integrity in conducting mental health research with adolescents. A balance is needed between protecting adolescents from exploitation and permitting access to benefits of research. Requiring parental consent for all research does not necessarily give effect to policy. For the vast majority of SA HIV-positive adolescents, parental consent is not possible. Section 71 of the NHA ought to be amended to facilitate valuable and necessary research concerning HIV-positive orphan children and adolescents.

High rates of viral suppression in adults and children with high CD4+ counts using a streamlined ART delivery model in the SEARCH trial in rural Uganda and Kenya.

Introduction: The 2015 WHO recommendation of antiretroviral therapy (ART) for all HIV-positive persons calls for treatment initiation in millions of persons newly eligible with high CD4+ counts. Efficient and effective care models are urgently needed for this population. We evaluated clinical outcomes of asymptomatic HIV-positive adults and children starting ART with high CD4+ counts using a novel streamlined care model in rural Uganda and Kenya.Methods: In the 16 intervention communities of the HIV test-and-treat Sustainable East Africa Research for Community Health Study (NCT01864603), all HIV-positive individuals irrespective of CD4 were offered ART (efavirenz [EFV]/tenofovir disoproxil fumarate + emtricitabine (FTC) or lamivudine (3TC). We studied adults (≥fifteen years) with CD4 ≥ 350/μL and children (two to fourteen years) with CD4 > 500/μL otherwise ineligible for ART by country guidelines. Clinics implemented a patient-centred streamlined care model designed to reduce patient-level barriers and maximize health system efficiency. It included (1) nurse-conducted visits with physician referral of complex cases, (2) multi-disease chronic care (including for hypertension/diabetes), (3) patient-centred, friendly staff, (4) viral load (VL) testing and counselling, (5) three-month return visits and ART refills, (6) appointment reminders, (7) tiered tracking for missed appointments, (8) flexible clinic hours (outside routine schedule) and (9) telephone access to clinicians. Primary outcomes were 48-week retention in care, viral suppression (% with measured week 48 VL ≤ 500 copies/mL) and adverse events.Results: Overall, 972 HIV-positive adults with CD4+ ≥ 350/μL initiated ART with streamlined care. Patients were 66% female and had median age thirty-four years (IQR, 28–42), CD4+ 608/μL (IQR, 487–788/μL) and VL 6775 copies/mL (IQR, <500–37,003 c/mL). At week 48, retention was 92% (897/972; 2 died/40 moved/8 withdrew/4 transferred care/21/964 [2%] were lost to follow-up). Viral suppression occurred in 778/838 (93%) and 800/972 (82%) in intention-to-treat analysis. Grade III/IV clinical/laboratory adverse events were rare: 95 occurred in 74/972 patients (7.6%). Only 8/972 adults (0.8%) switched ART from EFV to lopinavir (LPV) (n = 2 for dizziness, n = 2 for gynaecomastia, n = 4 for other reasons). Among 83 children, week 48 retention was 89% (74/83), viral suppression was 92% (65/71) and grade III/IV adverse events occurred in 4/83 (4.8%).Conclusions: Using a streamlined care model, viral suppression, retention and ART safety were high among asymptomatic East African adults and children with high CD4+ counts initiating treatment.Clinical Trial Number: NCT01864603

Study of tuberculosis in HIV positive children in a tertiary care hospital of Odisha

Background: Tuberculosis and HIV have been closely linked since the emergence of AIDS. Worldwide, TB is the most common opportunistic infection affecting HIV seropositive individuals and it remains the most common cause of death in patients with AIDS. HIV infection has contributed to a significant increase in the worldwide incidence of TB. So, an attempt was made in the present study to know the magnitude/extent of tuberculosis, associated clinical patterns, epidemiological factors and outcomes in HIV positive children attending the ART Centre of SCB medical college and hospital, Cuttack.Methods: A tertiary care hospital based prospective study was carried out in 50 children between 6 months to 14 years of age for a period of 2 years.Results: Most of the cases were less than 6 years old. TB was more common in male children than in females. Most cases were from rural areas. Majority belong to Class IV (Upper Lower) and Class V(Lower) socio-economic class. Most had Grade II and Grade III malnutrition as per IAP classification. Definite history of contact and recent infection was present in most. Majority (75%) had pulmonary tuberculosis. Pleural variant was predominant in extra-pulmonary form followed by TB lymphadenitis and disseminated forms. 5% had both PTB and EPTB. Most cases were un vaccinated. Common clinical features were fever, cough, FTT, chronic diarrhoea. Disseminated TB was common in unvaccinated group. Recovery pattern was almost similar in vaccinated and unvaccinated groups. Most of the PTB cases were cured of the disease with only 2 deaths in this group whereas the number of deaths, children going LAMA and development of MDR-TB was more in disseminated forms.Conclusions: Occurrence of TB is high in HIV positive cases. EPTB is common in unvaccinated cases. TB is common in rural and underprivileged children. Drug compliance is poor in disseminated forms. Mortality is high in disseminated forms. Sequele is more in disseminated forms of TB.

Going door-to-door to reach men and young people with HIV testing services to achieve the 90-90-90 treatment targets.

Setting: Mulanje District, Malawi. Objective: To examine the effectiveness of door-to-door (DtD) testing in reaching young people and men in a remote, rural area with a high prevalence of human immunodeficiency virus (HIV) infection. Design: This was a retrospective analysis of data collected for a pilot DtD program. HIV testing services (HTS) visited targeted villages for 1-2 weeks. All current residents aged ⩾2 years not known to be HIV-positive were offered testing. Results: Ninety per cent (13 783/15 391) of individuals eligible for testing accepted. Forty-one per cent (n = 5693) of those tested were males and 56% (n = 7752) were aged <20 years. The overall proportion who tested positive was 4% (n = 524), with half as many males as females testing positive (OR 0.49, 95%CI 0.40-0.60, P < 0.001). There was a higher positive yield rate for those aged ⩾20 years (6% for men and 8% for women). Two thirds were first-time testers; males were half as likely as females to have been previously tested (OR 0.43, 95%CI 0.40-0.47, P < 0.001). Conclusion: DtD-HTS can be an effective way to reach populations in remote, rural high-prevalence areas where access to fixed facilities is inadequate. It has the potential to reach young people and men better than facility-based testing or other community strategies, and can identify young HIV-positive children who may have been missed by other methods.

….So from then, we a bit freaky at home, we were scared: Challenges of Providing Foster Care to a Child Living with HIV in South Africa

Foster care is currently the main form of care available to HIV positive children in South Africa, who are no longer in the care of their parents. Thus, the importance of understanding the challenges and needs of foster carers could not be over-emphasized. This paper reports on a study that explored the experiences and needs of foster carers of HIV positive children in the Western Cape Province of South Africa. Participants were recruited from two organizations that provide services to HIV positive children and their foster carers in Cape Town. Grounded on family stress theory and systems theory, in-depth interviews were conducted with 18 foster carers of HIV positive children including 16 female carers and two male carers. Results indicated that the challenges facing foster carers are multifaceted and include the initial adjustment period, interactions with biological parents, finances, dual diagnoses, stigma and fear, the foster carers' own mental and physical health, management of the child's medication and dealing with the child's emotional pain. Health care services were found to be easily accessible, but social services and educational support proved to be a challenge to foster carers. This paper highlights the need for additional emotional support for foster carers and the importance of providing opportunities to voice their challenges and if needed, receive appropriate training and support.

Neurocognitive development in HIV-positive children is correlated with plasma viral loads in early childhood.

Because of neurocognitive impairments in perinatally human immunodeficiency virus (HIV)-infected children and adolescents, this study aimed to demonstrate the effect of plasma viral loads and early initiation of sufficient combined antiretroviral therapy (cART) on neurocognitive development.In total, 14 perinatally infected HIV-positive children (median age 8.24 years [range: 6.0-16.74]) receiving lopinavir/ritonavir (LPV/r)-based ART underwent neurocognitive testing using the Wechsler Intelligence Score for Children, 4th Edition (WISC-IV). All 14 patients participated in a pharmacokinetic study in which they were hospitalized for an entire day. As a child's ability to concentrate varies over the course of the day, all tests were performed in the morning.The patients' neurocognitive development did not significantly differ from the normative collective pattern for any of the following composite scores that were examined: full-scale intelligence quotient (IQ) (mean: 106.5, P = .1060), verbal comprehension index (mean: 106.0, P = .1356), perceptual reasoning index (mean: 106.0, P = .1357), working memory index (mean: 106.3, P = .1171), and processing speed index (mean: 98.1, P = .6313). The overall full-scale IQ scores were significantly higher in children who began ART within the first year of life (P = .0379), whereas low lopinavir/r plasma levels (P = .0070) and high viral load area under the curves (AUCs) in the first 3 years of life, but not later, significantly correlated with reduced neurocognitive performance (Spearman r = -0.64, P = .0278).In this cohort of cART treated HIV-positive children and adolescents, neurocognitive performance correlated with early and sufficient viral load suppression within the first 3 years of life.

Is salivary IgA level a potential biomarker for immunosuppression in HIV-positive children? A systematic review and meta-analysis.

The aim of this systematic review was to determine whether or not assessment of salivary secretory immunoglobulin A (sIgA) levels could be a potential biomarker for immunosuppression in HIV-positive children. The Patient, Exposure, Comparative, Outcome question was "Is sIgA level a potential biomarker for immunosuppression in HIV-positive children?" Electronic and manual literature searches were conducted in indexed databases (MEDLINE, PubMed, EMBASE, ScienceDirect, and SCOPUS databases) up to and including June 2017. The primary outcome was total mean salivary levels of IgA among HIV seropositive and seronegative children (controls). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for total mean salivary IgA levels were calculated using a random effect model. Six studies were included. Three studies showed significantly lower salivary IgA levels in HIV-infected children compared with controls. Two studies showed comparable IgA levels in HIV infected and controls. One study showed significantly higher levels of salivary IgA in HIV-infected children as compared to controls. Considering the total mean salivary IgA levels among HIV seropositive and seronegative children, a high degree of heterogeneity (Q value=254.09, P<.0001, I2 =98.82%) was noticed among both groups. The overall WMD was not significant (WMD=-1.18, 95% CI, -1.91 to -0.44, P=.39). Whether salivary IgA level is a potential biomarker for immunosuppression in HIV-positive children remains debatable because of limited information available in the current literature. Further, high-quality case-control studies with larger sample size and more solid methodological aspects are required.

HIV Disclosure: Parental Perceptions in Disclosing Perinatally HIV Infected Children about their HIV Positive Status

Background: The increased access to antiretroviral treatment resulted in increased survival rates among the children infected with HIV/AIDs and also led to the improved quality of life of sero-positive children. The chronic medical conditions in the paediatric population pose a range of potential psychosocial challenges and also disclosure of HIV status to the positive children. The current study aimed to understand the Parental Perceptions on Disclosure of diagnosis to their HIV Positive Children. Methodology : For this purpose the researcher used qualitative method in which 13 parents were interviewed to understand the parental perception about disclosure of HIV status to their perinatally infected children and challenges in disclosure. Results and Conclusion : The results were analyzed using thematic approach. The findings of the study showed lack of understanding of importance of disclosing HIV status to their positive children, fears of post disclosure impact and lack of consensus among few parents regarding who should disclose HIV status to the infected children and adolescents. Keywords: Children, disclosure, HIV/AIDS, perinatal, parents

Treatment outcome and associated factors of severe acute malnutrition among 6\u201359\xa0months old children in Debre Markos and Finote Selam hospitals, Northwest Ethiopia: a retrospective cohort study

BackgroundIn Ethiopia, the health sector has increased its efforts to enhance good nutritional practices through health education, treatment of extremely malnourished children and provision of micronutrients for mothers and children. But, the poor nutritional status of women and children continues to be still a major public health problem.MethodsA retrospective cohort study was conducted to assess the treatment outcome and associated factors of severe acute malnutrition among a total of 253 children age 6–59 months old. Severe acute malnutrition registration logbook and patient charts were used as a source of data. Data were entered in to Epi-data version 3.1 and exported to SPSS version 20 for analysis. To identify associated factors, Cox proportional hazard analysis was computed and p-value <0.05 at 95% confidence interval was considered as statistically significant.ResultsThe recovery rate was 77.9% and the overall median recovery time was 11 days. Those children age from 24 to 35 months had 34% lower probability of recovery from SAM compared to 6–11 months old children (AHR = 0.66, 95% CI: 0.35–0.89). Children whose ages from 36 to 59 months had 47% lower probability of recovery from SAM compared to 6–11 months old children (AHR = 0.53, 95% CI: 0.31–0.91). HIV negative children had 2.48 times higher probability of getting recovered from SAM compared to HIV positive children (AHR = 2.48, 95% CI: 1.23–5.01). Children who didn’t take folic acid supplement had 65% lower probability of recovery from SAM compared to children who took folic acid supplement (AHR = 0.35, 95% CI: 0.14–0.89).ConclusionsThis study found that recovery rate of 6–59 months old children treated for severe acute malnutrition in therapeutics units was in acceptable range based on the WHO recommendation. Folic acid supplementation and screening for HIV status should be promoted at all levels of health facilities during early age.

Could cash and good parenting affect child cognitive development? A cross-sectional study in South Africa and Malawi

BackgroundSocial protection interventions, including cash grants and care provision have been shown to effectively reduce some negative impacts of the HIV epidemic on adolescents and families. Less is known about the role of social protection on younger HIV affected populations. This study explored the impact of cash grants on children’s cognitive development. Additionally, we examined whether combined cash and care (operationalised as good parenting) was associated with improved cognitive outcomes.MethodsThe sample included 854 children, aged 5 – 15, participating in community-based organisation (CBO) programmes for children affected by HIV in South Africa and Malawi. Data on child cognitive functioning were gathered by a combination of caregiver report and observer administered tests. Primary caregivers also reported on the economic situation of the family, cash receipt into the home, child and household HIV status. Parenting was measured on a 10 item scale with good parenting defined as a score of 8 or above.ResultsAbout half of families received cash (55%, n = 473), only 6% (n = 51) reported good parenting above the cut-off point but no cash, 18% (n = 151) received combined cash support and reported good parenting, and 21% (n = 179) had neither. Findings show that cash receipt was associated with enhanced child cognitive outcomes in a number of domains including verbal working memory, general cognitive functioning, and learning. Furthermore, cash plus good parenting provided an additive effect. Child HIV status had a moderating effect on the association between cash or/plus good parenting and cognitive outcomes. The association between cash and good parenting and child cognitive outcomes remained significant among both HIV positive and negative children, but overall the HIV negative group benefited more.ConclusionsThis study shows the importance of cash transfers and good parenting on cognitive development of young children living in HIV affected environments. Our data clearly indicate that combined provision (cash plus good parenting) have added value.

The social stigma of HIV-AIDS: society's role.

AIDS is a devastating and deadly disease that affects people worldwide and, like all infections, it comes without warning. Specifically, childbearing women with AIDS face constant psychological difficulties during their gestation period, even though the pregnancy itself may be normal and healthy. These women have to deal with the uncertainties and the stress that usually accompany a pregnancy, and they have to live with the reality of having a life-threatening disease; in addition to that, they also have to deal with discriminating and stigmatizing behaviors from their environment. It is well known that a balanced mental state is a major determining factor to having a normal pregnancy and constitutes the starting point for having a good quality of life. Even though the progress in both technology and medicine is rapid, infected pregnant women seem to be missing this basic requirement. Communities seem unprepared and uneducated to smoothly integrate these people in their societies, letting the ignorance marginalize and isolate these patients. For all the aforementioned reasons, it is imperative that society and medical professionals respond and provide all the necessary support and advice to HIV-positive child bearers, in an attempt to allay their fears and relieve their distress. The purpose of this paper is to summarize the difficulties patients with HIV infection have to deal with, in order to survive and merge into society, identify the main reasons for the low public awareness, discuss the current situation, and provide potential solutions to reducing the stigma among HIV patients.

Psychiatric Morbidity in Children with HIV/AIDS at a Tertiary Health Institution in North-central Nigeria.

Children with human immunodeficiency virus (HIV) infection are living longer with the infection and are at risk of different complications. We assessed for the prevalence of and associated factors for psychiatric morbidity among HIV-infected children in a tertiary facility in Ilorin, Nigeria. A descriptive cross-sectional, two-staged study involving 196 HIV-positive children (6-17 years). A semi-structured questionnaire and psychological instruments were used for the study. Thirty-eight (19.4%) children had psychiatric disorders: attention-deficit hyperactivity disorder and enuresis. Single parenthood, HIV clinical stages and complications were associated with psychiatric morbidity. Linear combination of the risk factors was not related to the psychiatric disorder. Bivariate correlation analysis showed the tendency to develop psychiatric disorder among the children was positively correlated with complications in the child and the person the child resides with. Complicated HIV infection and adverse life events result in elevated risk of having psychiatric morbidity.

Improving feeding and growth of HIV-positive children through nutrition training of frontline health workers in Tanga, Tanzania

BackgroundNutrition training can boost competence of health workers to improve children’s feeding practices. In this way, child undernutrition can be ameliorated in general populations. However, evidence is lacking on efficacy of such interventions among Human Immunodeficiency Virus (HIV)-positive children. We aimed to examine the efficacy of a nutrition training intervention to improve midlevel providers’ (MLPs) nutrition knowledge and feeding practices and the nutrition statuses of HIV-positive children in Tanga, Tanzania.MethodsThis cluster-randomized controlled trial was conducted in 16 out of 32 care and treatment centers (CTCs) in Tanga. Eight CTCs were assigned to the intervention arm and a total of 16 MLPs received nutrition training and provided nutrition counseling and care to caregivers of HIV-positive children. A total of 776 pairs of HIV-positive children and their caregivers were recruited, of whom 397 were in the intervention arm. Data were analyzed using instrumental variable random effects regression with panel data to examine the efficacy of the intervention on nutrition status through feeding practices.ResultsMean nutrition knowledge scores were higher post-training compared to pre-training among MLPs (37.1 vs. 23.5, p < 0.001). A mean increment weight gain of 300 g was also observed at follow-up compared to baseline among children of the intervention arm. Feeding frequency and dietary diversity improved following the intervention and a 6 months follow-up (p < 0.001). An increase in each unit of feeding frequency and dietary diversity were associated with a 0.15-unit and a 0.16-unit respectively decrease in the child underweight (p < 0.001).ConclusionsNutrition training improved nutrition knowledge among MLPs caring for HIV-positive children attending CTCs in Tanga, Tanzania. Caregivers’ feeding practices also improved, which in turn led to a modest weight gain among HIV-positive children. To sustain weight gain, efforts should be made to also improve households’ food security and caregivers’ education in addition to inservice nutrition trainings. The protocol was registered on 15/02/2013, before the recruitment at ISRCTN trial registry with the trial registration number: ISRCTN65346364.

Clinico-Social and Immunological Profile of Antiretroviral Naïve Children Living With HIV In Tertiary Care Hospital, Delhi

Introduction: This study was undertaken to assess the clinical profile of children living with HIV at the time of their enrolment in an ART centre in Delhi. The study also attempts to understand association between clinical staging and immunological profile (CD4 count/percentage) in HIV infected children. The findings of this study may help policy makers to plan better health care of CLHIV in resource constrained country like India. The Objectives of the study were to assess the baseline clinico-social and immunological profile of HIV positive children before the start of Antiretroviral Therapy, to study clinicosocial and morbidity profile of HIV positive children at the time of their enrolment in ART centre and to study the association between immunodeficiency and clinical staging of CLHIV.Methodology: The present study, conducted between December 2012 and March 2013, is a retrospective case review of 83 antiretroviral naïve Children living with HIV aged 8 months to 13 years and attending paediatric ART clinic of a tertiary care hospital of Delhi. After the infection was established on serological grounds, information on socio-demographic, clinical and immunological profile was studied.Results: Majority (62.7%) of CLHIV were boys. Both parents of CLHIV were found to be positive in 63.9% while mother was found to be positive in 69.9%. The most common route of HIV infection was mother-to-child transmission (69.9%), followed by transmission though blood/blood products (12.0%). Every three out of four children (71.1%) were in WHO clinical stage III or IV. Three out of four (74.7%) children presented with fever, one in two with cough (56.6%). Diarrhoea (56.6%), pneumonia (41.0%), popular pruritic eruptions (18.1%), candidiasis (16.9%) and tuberculosis (14.5%) were the most common opportunistic infections in these children. The most common signs present were hepatomegaly (81.9%), anaemia (78.3%) and lymphadenopathy (72.3%).Conclusion: Mother to child transmission is the most common route of transmission in CLHIV. At enrolment more than half of the children were in clinical stage III&amp;IV. Fever, cough, diarrhoea, weight loss, rashes were common morbidities of the children. Majority of the children had hepatomegaly, anaemia and lymphadenopathy.SAARC J TUBER LUNG DIS HIV/AIDS, 2016; XIII(1) p.32-38

Optimal management of children on antiretroviral therapy (ART) in primary care: a quality improvement project

Introduction: With the large volumes of human immunodeficiency virus (HIV) positive patients in South Africa, one clinical management strategy has been to task shift. This means that previously hospi-centric HIV services have devolved to primary health care (PHC) clinics. The referral pattern is true for paediatric patients as well. With the added complexity of managing children, there was a concern in the research district that children were not being optimally managed at PHC level.&#x0D; &#x0D; Method: A quality improvement project was initiated to assess HIV-positive children’s management at PHC clinics and to implement an intervention to improve this care.&#x0D; &#x0D; Results: The initial audits of 624 children in the district revealed that only 66.6% of children had undetectable viral loads (VLs). Other poor indicators were lack of regular blood results, omission of prophylactic isoniazide (INH) and cotrimoxazole etc. Documents were disorganised and not standard across the district. The intervention sought to place the local clinic doctor as the champion in each clinic. A reorganised file was planned where all the care elements would be clearly present. &#x0D; &#x0D; Conclusion: Post intervention, it was clear that where individual doctors took on the challenge of quality improvement there were significant process changes. Results are discussed in detail.&#x0D; &#x0D; (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)&#x0D; &#x0D; S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1254928