title: Routine inpatient human immunodeficiency virus testing system increases access to pediatric human immunodeficiency virus care in sub-Saharan Africa.
abstract: 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.
authors.affiliation: Baylor International Pediatric AIDS Initiative, Baylor College of Medicine, Lilongwe, Malawi. ericdmccollum@gmail.com
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Preidis
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Golitko
authors.forename: Linias D
authors.initials: LD
authors.lastname: Siwande
authors.forename: Charles
authors.initials: C
authors.lastname: Mwansambo
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Gordon E
authors.initials: GE
authors.lastname: Schutze
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kline
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D016133:Polymerase Chain Reaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome