title: Failure to test children of HIV-infected mothers in South Africa: implications for HIV testing strategies for preschool children.
abstract: OBJECTIVE
  To assess the uptake of HIV testing among preschool children with HIV-positive mothers in a peri-urban population-based study in KwaZulu-Natal, South Africa, an area of high HIV prevalence.
  
  
  METHODS
  All children 4-6 years old and their primary caregivers from the area were invited to participate. All participants were asked about prior HIV testing and were offered counselling and voluntary HIV testing irrespective of previous testing. Twenty-seven HIV-infected mothers were interviewed to identify barriers to testing their children.
  
  
  RESULTS
  One thousand five hundred and eighty-three children (88% of eligible children) and their caregivers participated. Of the biological mothers, 86% were previously tested for HIV (27% tested positive). Among the surviving 244 children born to an infected mother, only 41% had been tested for HIV (23% tested positive). Subsequently, 90% of previously untested children of infected mothers underwent HIV testing (9.3% were positive). Overall seroprevalence among study children was 4.9%. All infected mothers interviewed endorsed the belief that children of HIV-infected women should be tested for HIV. Women who missed opportunities for antenatal HIV testing reported no systematic testing of their children at later ages.
  
  
  CONCLUSIONS
  In this community with high HIV prevalence, HIV testing of children is infrequent despite high testing coverage among caregivers. The low proportion of children tested for HIV, particularly those of infected mothers, is of great concern as they are at high risk for morbidity and mortality associated with untreated childhood HIV infection. HIV testing programs should strengthen protocols to include children, especially for those who missed PMTCT opportunities in infancy.
authors: Department of Paediatrics and Child Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
authors: Meera K
authors: MK
authors: Chhagan
authors: Shuaib
authors: S
authors: Kauchali
authors: Stephen M
authors: SM
authors: Arpadi
authors: Murray H
authors: MH
authors: Craib
authors: Fatimatou
authors: F
authors: Bah
authors: Zena
authors: Z
authors: Stein
authors: Leslie L
authors: LL
authors: Davidson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D015528:HIV Seroprevalence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult