Routine offering of HIV testing to hospitalized paediatric

Routine offering of HIV testing to hospitalized paediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility.

The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. Kankasa and colleagues implemented routine HIV antibody counselling and testing for paediatric patients hospitalized at the University Teaching Hospital, a national reference centre, in Lusaka, Zambia. They also introduced HIV DNA polymerase chain reaction testing for early infant diagnosis. Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counselling and testing for their children. HIV antibody positive (HIV+) children <18>Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18>. The proportion of counselled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P <>polymerase chain reaction tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6>

Globally, the number of children under 15 years of age who received antiretroviral treatment rose from 198,000 in 2007 to 275, 000 in 2008; however, a striking 62% of children in low- and middle-income countries who need antiretroviral treatment are not receiving it. Among the many barriers to overcome in the scale-up of paediatric HIV treatment to universal access, the major gatekeeper is identifying children with HIV infection. Before the study began in this Lusaka referral hospital, children were sent to adjacent voluntary testing and counselling centres for determination of serostatus. The uptake of paediatric testing among caregivers that were counselled on the wards increased over time to an overall 87%. The result was that 29% of the children tested were found to be HIV-antibody positive, 63% of whom were infected. There is no doubt that referral hospitals in high HIV prevalence countries can increase paediatric-testing uptake dramatically if HIV counselling and testing are offered routinely at the point of care .