A two-year clinic-based HIV testing program in Zimbabwe failed to diagnose many cases of HIV in children in the surrounding area, Dr. Victoria Simms from the London School of Hygiene & Tropical Medicine, UK, and colleagues, report in PLOS Medicine.
Worldwide, an estimated 1.8 million children under the age of 15 are living with HIV, most in sub-Saharan Africa, and they often go without treatment due to under-diagnosis. In the new study, researchers at the Biomedical Research and Training Institute launched a provider-initiated testing and counseling (PITC) program in Harare, Zimbabwe, offering an HIV test to every child aged 6-15 who came into any of 7 local clinics during a two-year timespan. After the two years, the researchers did a house-to-house survey in the same area, testing children aged 8-17 for HIV using an oral test.
2.6% (95% CI 2.2-3.1%) of children tested in the house-to-house survey were HIV positive, and over a third of those (37.7%; 95% CI 29.8-46.2%) were undiagnosed. Based on the survey results, the researchers estimated that the two year PITC program had identified between 18% and 42% of previously undiagnosed children in the community. This extrapolation is limited by the lack of a baseline survey. In addition, under-reporting of known HIV infection is an inherent problem when using self-report.
"In order to diagnose all children with HIV it is not enough to test every child who comes to a clinic, because some HIV positive children either do not visit a clinic often or do not go with a guardian able to give consent for them to take an HIV test," the authors say. "Other methods, such as community-based testing or targeted tracing, must be tried to reach the children who cannot be tested in the clinic."
In an accompanying Perspective, Marguerite Lightfoot of the University of California San Francisco and colleagues discuss the limitations and challenges of PITC to diagnose HIV in children and adolescents. "PITC can play an important role in increasing uptake of testing among older children and adolescents, but needs to better address barriers to testing in this population, and is likely not sufficient on its own," they write.
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Research Article
Funding:
The study was funded by the Wellcome Trust http://www.wellcome.ac.uk through an Intermediate Fellowship awarded to RAF (095878/Z/11/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Simms V, Dauya E, Dakshina S, Bandason T, McHugh G, Munyati S, et al. (2017) Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey. PLoS Med 14(7): e1002360. https://doi.org/10.1371/journal.pmed.1002360
Author Affiliations:
MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
Biomedical Research and Training Institute, Harare, Zimbabwe
Harare City Health, Harare, Zimbabwe
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
Ministry of Health and Child Care, Harare, Zimbabwe
African Institute of Biomedical Science & Technology, Harare, Zimbabwe
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002360
Perspective Article
Funding:
SDW receives salary support from NIH grants R01MH107330 and R01MH095683. The funders had no role in decision to publish or preparation of the manuscript.
Competing Interests:
SDW is a member of the Editorial Board of PLOS Medicine.
Citation:
Lightfoot M, Dunbar M, Weiser SD (2017) Reducing undiagnosed HIV infection among adolescents in sub-Saharan Africa: Provider-initiated and opt-out testing are not enough. PLoS Med 14(7): e1002361. https://doi.org/10.1371/journal.pmed.1002361
Author Affiliations:
Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
Pangaea Zimbabwe AIDS Trust, Harare, Zimbabwe
Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002361
Journal
PLoS Medicine