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Pediatric human immunodeficiency virus screening in an African district hospital
A J De Baets1, B S Edidi, M J Kasali
1Nutrition and Child Health Unit, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium. anisah2@attglobal.net
Insights
This study explored simplified pediatric HIV screening in Congo using capillary blood tests. Results show high accuracy, suggesting easier and less painful HIV testing for children.
Area of Science:
- Pediatric infectious diseases
- Clinical diagnostics
- Public health interventions
Background:
- Pediatric HIV screening at district hospitals faces challenges in simplicity and accessibility.
- Current methods may involve complex procedures and potential discomfort for children.
Purpose of the Study:
- To evaluate alternative, simplified strategies for pediatric human immunodeficiency virus (HIV) screening.
- To assess the feasibility of using capillary blood and rapid tests for efficient screening.
- To reduce procedural pain and needle-stick injury risks in pediatric phlebotomy.
Main Methods:
- A cross-sectional exploratory study involving 941 Congolese children (1 month to 12 years).
- Comparison of venous and capillary blood collection methods.
- Utilized serial rapid HIV tests (Determine, InstantScreen, Uni-Gold) and an ultrasensitive p24 antigen assay.
- Investigated the use of glucolets for capillary phlebotomy.
Main Results:
- HIV prevalence was 4.7% in the study population.
- An algorithm using serial rapid tests on capillary blood achieved 100.0% sensitivity and specificity in children over 18 months.
- The ultrasensitive p24 antigen assay showed 100.0% sensitivity and specificity on capillary plasma stored on filter paper.
- Glucolets offered a less painful alternative to syringes, with comparable costs and reduced injury risks.
Conclusions:
- Simplified phlebotomy techniques, such as using glucolets, can enhance pediatric HIV screening.
- Capillary blood-based rapid testing algorithms demonstrate high accuracy for pediatric HIV diagnosis.
- Opportunities exist to improve the efficiency and patient experience of pediatric HIV screening at the district hospital level.
Abstract:
In order to evaluate alternative tests and strategies to simplify pediatric human immunodeficiency virus (HIV) screening at the district hospital level, a cross-sectional exploratory study was organized in the Democratic Republic of the Congo. Venous and capillary phlebotomies were performed on 941 Congolese children, aged 1 month to 12 years (153 children under 18 months and 788 children more than 18 months old). The HIV prevalence rate was 4.7%. An algorithm for children more than 18 months old, using serial rapid tests (Determine, InstantScreen, and Uni-Gold) performed on capillary blood stored in EDTA tubes, had a sensitivity of 100.0% (95% confidence interval [CI], 88.9 to 100.0%) and a specificity of 100.0% (95% CI, 99.5 to 100.0%). The results of this study suggest that the ultrasensitive p24 antigen assay may be performed on capillary plasma stored on filter paper (sensitivity and specificity, 100.0%; n=87) instead of venous plasma (sensitivity, 92.3%; specificity, 100.0%; n=150). The use of glucolets (instruments used to perform capillary phlebotomies), instead of syringes and needles, may reduce procedural pain and the risk of needle stick injuries at a comparable cost. Compared to the reference, HIV could have been correctly excluded based on one rapid test for at least 90% of these children. The results of this study point towards underutilized opportunities to simplify phlebotomy and pediatric HIV screening.
