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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Routine inpatient human immunodeficiency virus testing system increases access to pediatric human immunodeficiency
Eric D McCollum1, Geoffrey A Preidis, Carrie L Golitko
1Baylor International Pediatric AIDS Initiative, Baylor College of Medicine, Lilongwe, Malawi. ericdmccollum@gmail.com
Insights
Provider-initiated opt-out HIV testing and counseling (PITC) significantly improved pediatric HIV care access in Malawi. This routine testing strategy increased HIV diagnosis, inpatient care, and antiretroviral therapy initiation for hospitalized children.
Area of Science:
- Global Health
- Pediatric Infectious Diseases
- Public Health Interventions
Background:
- Routine Human Immunodeficiency Virus (HIV) testing, known as provider-initiated opt-out HIV testing and counseling (PITC), is recommended in high-prevalence African nations.
- The impact of PITC on pediatric HIV care access remains understudied.
- The Baylor International Pediatric AIDS Initiative (BIPAI) introduced PITC at a Malawian hospital in 2008.
Purpose of the Study:
- To evaluate the effectiveness of BIPAI-PITC compared to non-routine HIV testing (NRT) in improving pediatric HIV care access.
- To assess the influence of PITC on inpatient and outpatient HIV care utilization for children.
Main Methods:
- A retrospective study analyzed data from 7077 pediatric inpatients over sequential 4-month periods of NRT and BIPAI-PITC.
- In-hospital and 1-year outcomes were compared for 337 HIV-infected and HIV-exposed uninfected children not previously in HIV care.
Main Results:
- BIPAI-PITC significantly increased HIV testing rates among hospitalized children (81.0% vs. 33.3%).
- PITC led to greater access to inpatient HIV care (7.5% vs. 2.4%), outpatient clinic enrollment (3.2% vs. 1.3%), and antiretroviral therapy (ART) initiation (1.1% vs. 0.6%).
- PITC improved DNA polymerase chain reaction testing for HIV-infected/exposed children (73.5% vs. 35.2%) but did not enhance outpatient enrollment or ART initiation for identified HIV-infected patients.
Conclusions:
- BIPAI-PITC demonstrably enhances access to pediatric HIV care, including diagnostic testing and ART, for hospitalized children.
- Wider adoption of PITC, alongside increased pediatric HIV-trained clinicians and improved defaulter tracking, is crucial for global pediatric HIV service utilization.
Background:
Routine Human Immunodeficiency Virus (HIV) testing, called provider-initiated opt-out HIV testing and counseling (PITC), is recommended in African countries with high HIV prevalence. However, it is unknown whether PITC increases access to pediatric HIV care. In 2008, the Baylor International Pediatric AIDS Initiative implemented PITC (BIPAI-PITC) at a Malawian hospital. We sought to evaluate the influence of BIPAI-PITC, compared with nonroutine HIV testing (NRT), on pediatric HIV care access.
Methods:
Retrospective data from 7077 pediatric inpatients were collected during sequential 4-month periods of NRT and BIPAI-PITC. In-hospital and 1-year outcomes for 337 HIV-infected and HIV-exposed uninfected inpatients not previously enrolled in HIV care were analyzed to assess the clinical influence of each testing strategy.
Results:
During BIPAI-PITC, a greater proportion of all hospitalized children received HIV testing (81.0% vs. 33.3%, P < 0.001), accessed inpatient HIV-trained care (7.5% vs. 2.4%, P < 0.001), enrolled into an outpatient HIV clinic after discharge (3.2% vs. 1.3%, P < 0.001), and initiated antiretroviral therapy (ART) after hospitalization (1.1% vs. 0.6%, P = 0.010) compared with NRT. Additionally, BIPAI-PITC increased the proportion of hospitalized HIV-infected and HIV-exposed uninfected children receiving DNA polymerase chain reaction testing (73.5% vs. 35.2%, P < 0.001), but did not improve outpatient enrollment or ART initiation of identified HIV-infected patients.
Conclusions:
BIPAI-PITC increases access to inpatient and outpatient pediatric HIV care for hospitalized children, including DNA polymerase chain reaction testing and ART. Broader implementation of BIPAI-PITC or similar approaches, along with more pediatric HIV-trained clinicians and improved defaulter-tracking methods, would improve pediatric HIV service utilization globally.
