Where have all the children gone? High HIV prevalence in infants attending nutrition and inpatient entry points
Where have all the children gone? High HIV prevalence in infants attending nutrition and inpatient entry points
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DOI：
10.1002/jia2.25089
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发表时间：
2018-02-26
影响因子：
6
通讯作者：
Vojnov, Lara
中科院分区：
文献类型：
--
作者：
Kiyaga, Charles;Urick, Brittany;Vojnov, Lara
简介：尽管在预防母婴传播方面取得了显着进展，但撒哈拉以南非洲地区只有 50% 的艾滋病毒暴露婴儿在出生后头 2 个月内接受了检测，并且只有 30% 的艾滋病毒感染婴儿接受了抗逆转录病毒治疗。本研究评估了乌干达初级卫生保健机构各个服务入口处接受护理的婴儿和儿童的艾滋病毒感染率。方法：在乌干达四家地区医院系统地招募了 3600 名 24 个月以下的婴儿并进行了检测。纳入了 600 名婴儿，并从六个机构入口点进行了测试：PMTCT、免疫、住院、营养、门诊和社区外展服务。结果：传统 EID 入口点 PMTCT 的患病率为 3.8%，占研究中确定的 HIV 阳性婴儿总数的 19.6%。在 117 名已确定的 HIV 阳性婴儿中，有 50% 是在营养病房中发现的，其患病率为 9.8%（与 PMTCT 相比，p < 0.001）。住院病房的感染率为 3.5%，所发现的 HIV 阳性婴儿中有 17.9%。在免疫病房和通过外展服务进行检测的婴儿分别识别出 0.8% 和 1.7% 的 HIV 阳性婴儿，患病率低于 0.3%。结论：将常规婴儿早期诊断筛查范围从传统的 PMTCT 环境扩展到营养和住院入口点，将增加 HIV 感染婴儿的识别率。鉴于预期的低流行率，应考虑在免疫和外展服务中仔细考虑适当的检测策略，例如孕产妇重新检测，以确定新的艾滋病毒感染和需要后续检测和护理的艾滋病毒暴露婴儿。这些发现可能有助于艾滋病毒护理计划显着扩大检测范围，以改善婴儿早期诊断和儿科治疗的机会。
Introduction: Despite notable progress towards PMTCT, only 50% of HIV-exposed infants in sub-Saharan Africa were tested within the first 2 months of life and only 30% of HIV-infected infants are on antiretroviral treatment. This study assessed HIV prevalence in infants and children receiving care at various service entry points in primary healthcare facilities in Uganda.Methods: A total of 3600 infants up to 24 months of age were systematically enrolled and tested at four regional hospitals across Uganda. Six hundred infants were included and tested from six facility entry points: PMTCT, immunization, inpatient, nutrition, outpatient and community outreach services.Findings: The traditional EID entry point, PMTCT, had a prevalence of 3.8%, representing 19.6% of the total HIV-positive infants identified in the study. Fifty percent of the 117 identified HIV-positive infants were found in the nutrition wards, which had a prevalence of 9.8% (p < 0.001 compared to PMTCT). Inpatient wards had a prevalence of 3.5% and yielded 17.9% of the HIV-positive infants identified. Infants tested at immunization wards and through outreach services identified 0.8% and 1.7% of the HIV-positive infants respectively, and had a prevalence of less than 0.3%.Conclusions: Expanding routine early infant diagnosis screening beyond the traditional PMTCT setting to nutrition and inpatient entry points will increase the identification of HIV-infected infants. Careful reflection for appropriate testing strategies, such as maternal re-testing to identify new HIV infections and HIV-exposed infants in need of follow-up testing and care, at immunization and outreach services should be considered given the expectedly low prevalence rates. These findings may help HIV care programmes significantly expand testing to improve access to early infant diagnosis and paediatric treatment.