Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice.
Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003-2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18-29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis.
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya h.a.b.prins@gmail.com.
Henrieke A B
HA
Prins
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya.
Peter
P
Mugo
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya.
Elizabeth
E
Wahome
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya.
Grace
G
Mwashigadi
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya.
Alexander
A
Thiong'o
Nuffield Department of Population Health, University of Oxford, Oxford OX3 7BN, UK.
Adrian
A
Smith
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7BN, UK.
Eduard J
EJ
Sanders
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya University of Washington, Seattle, WA 98195, USA.
Susan M
SM
Graham
D000328:Adult; D017954:Africa South of the Sahara; D054869:Clinical Audit; D003695:Delivery of Health Care / Q000592:standards*; D003937:Diagnosis, Differential; D005334:Fever / Q000209:etiology*; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D015497:HIV-1; D006801:Humans; D007630:Kenya; D017410:Practice Guidelines as Topic / Q000592:standards; D055815:Young Adult
Acute disease; Adults; Fever; HIV-1; Outpatients; Sub-Saharan Africa