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Published on: October 31, 2010
Clinical and operational factors associated with low pediatric inpatient HIV testing coverage in Mozambique
C Nhabomba1,2, S Chicumbe3, H Muquingue4
1Centro de Investigação Operacional da Beira, Instituto Nacional de Saúde Beira, Mozambique.
Insights
Provider-initiated testing and counseling (PITC) for HIV in Mozambican pediatric wards was low, despite high HIV positivity rates. This indicates missed opportunities for diagnosis and treatment linkage in children.
Area of Science:
- Pediatric infectious diseases
- Public health
- HIV/AIDS research
Background:
- Provider-initiated testing and counseling (PITC) is crucial for pediatric HIV diagnosis.
- Understanding PITC coverage and outcomes in resource-limited settings is essential for improving child health.
- Mozambique faces significant challenges in pediatric HIV care and treatment.
Purpose of the Study:
- To determine PITC coverage and HIV positivity rates among children admitted to pediatric wards in Maputo Province.
- To identify clinical and facility-level factors associated with PITC.
- To assess the care cascade for HIV-exposed and -infected children.
Main Methods:
- Cross-sectional, retrospective review of inpatient charts for children aged 0-4 years.
- Systematic randomization of patient charts from eleven pediatric wards in Maputo Province.
- Data collection on HIV testing, positivity, and antiretroviral treatment initiation.
Main Results:
- HIV testing was ordered in 46.0% of eligible patients, with documented results for 35.7%, and 8.3% positivity.
- Highest PITC rates were observed for malnutrition, sepsis, and tuberculosis diagnoses.
- Longer hospitalization, weekday admission, and staff training were associated with better PITC performance; 29.6% initiated ART during hospitalization.
Conclusions:
- PITC coverage was low, with high HIV positivity rates, indicating missed opportunities for diagnosis and treatment linkage.
- Strengthened routine HIV testing on pediatric wards is needed.
- Inpatient initiation of antiretroviral therapy (ART) should be considered to improve pediatric HIV outcomes and progress towards the 90-90-90 goals.
Setting:
Eleven pediatric wards in Maputo Province, Mozambique.
Objective:
1) To determine provider-initiated testing and counseling (PITC) coverage, the rate of human immunodeficiency virus (HIV) positivity, and the clinical and facility-level variables associated with PITC; and 2) to assess the care cascade for HIV-exposed and -infected children.
Design:
This was a cross-sectional, retrospective review of inpatient charts, selected via systematic randomization, of patients aged 0-4 years, admitted between July and December 2015.
Results:
Among the 800 patients included, the median age was 23 months and median duration of hospitalization was 3 days. HIV testing was ordered in 46.0% of eligible patients (known HIV-infected at admission excluded), with results documented for 35.7%, of whom 8.3% were positive. The patient hospitalization diagnoses with the highest PITC rates were malnutrition (73.8%), sepsis (71.4%) and tuberculosis (58.3%), with positivity rates of respectively 16.1%, 20.0%, and 28.6%. Longer hospitalization, weekday admission, and PITC training for staff were significantly associated with better PITC performance. Antiretroviral treatment was initiated during hospitalization for 29.6% of eligible patients.
Conclusion:
PITC coverage was low, with high HIV positivity rates, highlighting missed opportunities for diagnosis and linkage to treatment. Strengthened routine testing on wards with consideration of inpatient ART initiation are needed to help achieve pediatric 90-90-90 goals.
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