Population Council Research that makes a difference

XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010

Abstract

"Missed opportunities to initiate pediatric HIV testing at ART sites"
Meredith Sheehy, Scott Kellerman, Waimar Tun, Nomtandazo Mini, Fiona Scorgie, and Tonicah Maphanga

Background
South Africa has the highest burden of HIV-infected children in the world. Despite progress in provision of adult HIV counseling and testing, few opportunities exist for pediatric testing beyond prevention of mother-to-child transmission (PMTCT) programs, resulting in late testing of HIV-exposed children. Insufficient identification of HIV- infected children is a primary barrier to effectively delivering pediatric HIV care and treatment.

Methods
In 2009, field staff surveyed 1,848 adult ART patients over a six-month period at four ART sites in Mdantsane Township, East London, to determine the coverage of HIV testing among their biological children aged 0–14 years. Field staff explained the importance of testing children to these patients and distributed referral cards linked to local health facilities offering pediatric testing.

Results
The average age of ART patients was 33.8 years. The majority (87.5%) were female, and 74.6 percent reported being single with an average of 1.5 biological children aged 0–14 years. Respondents reported a total of 2,840 biological children between the ages of 0 and 14 years, with 90.6 percent (2,572) of these living in their care. Of the 2,840 children, over one-half (68.2%) had never been tested. Among previously tested children, 58.1 percent had received testing before three months of age. A total of 86 children (mean age 4.1 years), were brought for testing by their referred caregiver during the study period: 7 were positive (8.1%), 71 negative, and 8 await results. ART patients diagnosed for less than one year were least likely to have tested their children.

Conclusions
A large number of children of ART patients remain untested. HIV-positive women undiagnosed at time of pregnancy and those not accessing PMTCT services will have exposed and untested children. Integrating provider-initiated referrals for pediatric testing at ART sites could help identify previously undiagnosed HIV-infected children before they become symptomatic.

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