HIV testing for children

HIV testing for children

It is important that HIV infected children are diagnosed as quickly as possible, so they can be provided with appropriate medication and care. However, testing children for HIV can be complicated, especially for those recently born to HIV-positive mothers. Antibody tests, which are used to diagnose HIV in adults, are ineffective in children below the age of 18 months. Instead, children below this age are usually diagnosed through polymerase chain reaction (PCR) testing and other specialist techniques. This is referred to as early infant diagnosis and is important because mortality is very high amongst HIV infected infants who go untreated. However, according to recent data, only an estimated 6% of children born to HIV positive mothers received an HIV test within the first two months of life. ³⁰

A multi country study in Africa showed that without treatment, half of HIV infected children die by 2 years of age.³¹ Even when children do survive into adolescence without treatment, they are likely to be stunted, severely underweight or suffering from opportunistic infections.³² However, the methods for testing children early require expensive laboratory equipment and specially trained staff which are generally unobtainable in the resource-poor areas where they are needed the most.

The use of dried blood spot testing can be more practical in resource poor settings. This method allows small samples of blood to be collected on paper, and sent away to a laboratory where PCR (or similar testing) is available. Unlike testing methods that use liquid samples, dried blood spots can be stored for a long time and easily transported, so even if the nearest laboratory is some distance away, it may still be possible to use PCR technology on a sample of a child’s blood. However, dried blood spot testing can be expensive and it can take a long time for test results to return.

Where health facilities can diagnose infants early through PCR testing they should immediately be linked to care and treatment services. However, an increase in access to testing is not always matched with access to treatment. One study in Cameroon found that only a third of infants who had been diagnosed early were alive and receiving treatment after one and a half years and another multi country study found that half of all infants who had tested HIV positive were not receiving treatment.³³ A multi-country review of developing countries conducted in 2009 found that only one quarter to one third of children who were tested early actually went on to start treatment