title: HIV counselling and testing practices for children seen in an urban emergency department of a tertiary referral hospital in Dar es Salaam, Tanzania: a retrospective cross-sectional study.
abstract: OBJECTIVE
  To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country.
  
  
  METHODS
  The ED of a large east African national referral hospital.
  
  
  METHODS
  This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male.
  
  
  METHODS
  The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive.
  
  
  RESULTS
  Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge.
  
  
  CONCLUSIONS
  Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care.
authors.affiliation: Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Hendry R
authors.initials: HR
authors.lastname: Sawe
authors.affiliation: Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Juma A
authors.initials: JA
authors.lastname: Mfinanga
authors.affiliation: Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Faith H
authors.initials: FH
authors.lastname: Ringo
authors.affiliation: Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Victor
authors.initials: V
authors.lastname: Mwafongo
authors.affiliation: Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Department of Emergency Medicine and Global Health Sciences, University of California, San Francisco, California, USA.
authors.forename: Teri A
authors.initials: TA
authors.lastname: Reynolds
authors.affiliation: Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Runyon
mesh_terms: D002675:Child, Preschool; D003376:Counseling / Q000379:methods*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D013636:Tanzania; D062606:Tertiary Care Centers
keywords: Emergency medicine; HIV counseling; HIV testing