Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility.
OBJECTIVE
The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide.


METHODS
We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis.


METHODS
Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA.


RESULTS
From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. 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 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001).


CONCLUSIONS
Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
Kankasa
Chipepo
C
Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
Carter
Rosalind J
RJ
Briggs
Nancy
N
Bulterys
Marc
M
Chama
Eslone
E
Cooper
Ellen R
ER
Costa
Cristiane
C
Spielman
Erica
E
Katepa-Bwalya
Mary
M
M'soka
Tendai
T
Ou
Chin-Yih
CY
Abrams
Elaine J
EJ
D017028:Caregivers; D002675:Child, Preschool; D003376:Counseling; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007258:Informed Consent; D008297:Male; D010290:Parents; D016133:Polymerase Chain Reaction; D015024:Zambia / Q000453:epidemiology
D004279:DNA, Viral; D015483:HIV Antibodies