title: Pediatric human immunodeficiency virus screening in an African district hospital.
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.
authors.affiliation: Nutrition and Child Health Unit, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium. anisah2@attglobal.net
authors.forename: A J
authors.initials: AJ
authors.lastname: De Baets
authors.forename: B S
authors.initials: BS
authors.lastname: Edidi
authors.forename: M J
authors.initials: MJ
authors.lastname: Kasali
authors.forename: G
authors.initials: G
authors.lastname: Beelaert
authors.forename: W
authors.initials: W
authors.lastname: Schrooten
authors.forename: A
authors.initials: A
authors.lastname: Litzroth
authors.forename: P
authors.initials: P
authors.lastname: Kolsteren
authors.forename: D
authors.initials: D
authors.lastname: Denolf
authors.forename: K
authors.initials: K
authors.lastname: Fransen
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods; D000465:Algorithms; D000818:Animals; D001793:Blood Preservation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D006678:HIV; D016655:HIV Core Protein p24 / Q000276:immunology; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis*; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening / Q000379:methods; D018962:Phlebotomy / Q000295:instrumentation; D012680:Sensitivity and Specificity; D016036:Seroepidemiologic Studies
chemical_list: D016655:HIV Core Protein p24