Simple Screening Tool to Help Identify High-Risk Children for Targeted HIV Testing in Malawian Inpatient Wards
Simple Screening Tool to Help Identify High-Risk Children for Targeted HIV Testing in Malawian Inpatient Wards
复制标题
DOI：
10.1097/qai.0000000000001804
复制
发表时间：
2018-11-01
影响因子：
3.6
通讯作者：
Hoffman, Risa M.
中科院分区：
文献类型：
--
作者：
Moucheraud, Corrina;Chasweka, Dennis;Hoffman, Risa M.
背景：为了实现全球艾滋病目标，必须加强儿科艾滋病毒诊断。世卫组织建议的由提供者发起的检测和咨询在资源匮乏的环境中面临持续的实施挑战。背景：马拉维已经实现了艾滋病毒诊断和治疗的高覆盖率，但在儿科人群中存在差距。本研究评估的敏感性和特异性的一个简短的筛选工具，以确定有风险的儿科患者有针对性的HIV testing in Malawi.Methods：包含6是/否项目的工具被用于儿童（1-15岁）在住院儿科病房在马拉维的12家医院（2016年7月至2017年7月）。问题是根据一个既定的工具，翻译成齐切瓦语，并由艾滋病毒诊断助理执行。所有参与的儿童都按照卫生部的指导方针接受了艾滋病毒检测和咨询。分析估计该工具的特点，包括敏感性，特异性，阴性，阳性predictionvalues.Results：8602参与者中的艾滋病病毒感染率为1.1%（n = 90）。筛查工具得分为1的儿童艾滋病毒阳性的几率是得分为0的儿童的两倍。经常患病是HIV感染状况最敏感的预测因子（55.1%），而父母一方死亡是最特异的预测因子（96.7%）。艾滋病毒阴性状态的错误分类是罕见的（n = 14），但更经常发生在男孩和年幼的child.Conclusions：一个简短的筛选工具，儿科住院患者帮助目标艾滋病毒检测的风险最低的儿科患病率，资源有限的设置。未来的研究应包括与PITC的直接，严格的比较，包括比较有效性，效率和成本效益。
Background: To meet global AIDS goals, pediatric HIV diagnosis must be strengthened. Provider-initiated testing and counseling, which is recommended by the WHO, faces persistent implementation challenges in low-resource settings. Alternative approaches are needed.Setting: Malawi has achieved high coverage of HIV diagnosis and treatment, but there are gaps among pediatric populations. This study assessed the sensitivity and specificity of a brief screening tool to identify at-risk pediatric patients for targeted HIV testing in Malawi.Methods: A tool containing 6 yes/no items was used for children (aged 1-15 years) in the inpatient pediatric wards at 12 hospitals in Malawi (July 2016-July 2017). Questions were based on an established tool, translated to Chichewa, and implemented by HIV diagnostic assistants. All participating children were provided HIV testing and counseling per Ministry of Health guidelines. Analysis estimated the tool's characteristics including sensitivity, specificity, negative, and positive predictive values.Results: HIV prevalence among the 8602 participants was 1.1% (n = 90). Children with a screening tool score of 1 had double the odds of being HIV positive than those with a score of 0. Frequent sickness was the most sensitive predictor of HIV status (55.1%), and having a deceased parent was the most specific (96.7%). False classification of HIV-negative status was rare (n = 14) but occurred more often among boys and younger children.Conclusions: A brief screening tool for pediatric inpatients helped target HIV testing in those most at risk in a low-pediatric-prevalence, resource-constrained setting. Future research should include a direct, rigorous comparison with PITC including comparative effectiveness, efficiency, and cost effectiveness.