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Routine Inpatient Human Immunodeficiency Virus Testing System Increases Access to Pediatric Human Immunodeficiency Virus Care in Sub-Saharan Africa

McCollum, Eric D. MD*†‡; Preidis, Geoffrey A. PhD§; Golitko, Carrie L. MD*; Siwande, Linias D. RN; Mwansambo, Charles MB CHB, FRCP; Kazembe, Peter N. MB CHB, FRCP; Hoffman, Irving PA, MPH; Hosseinipour, Mina C. MD, MPH‡∥; Schutze, Gordon E. MD**; Kline, Mark W. MD**

The Pediatric Infectious Disease Journal: May 2011 - Volume 30 - Issue 5 - p e75-e81
doi: 10.1097/INF.0b013e3182103f8a
Online-Only: Original Studies

Background: Routine Human Immunodeficiency Virus (HIV) testing, called provider-initiated opt-out HIV testing and counseling (PITC), is recommended in African countries with high HIV prevalence. However, it is unknown whether PITC increases access to pediatric HIV care. In 2008, the Baylor International Pediatric AIDS Initiative implemented PITC (BIPAI-PITC) at a Malawian hospital. We sought to evaluate the influence of BIPAI-PITC, compared with nonroutine HIV testing (NRT), on pediatric HIV care access.

Methods: Retrospective data from 7077 pediatric inpatients were collected during sequential 4-month periods of NRT and BIPAI-PITC. In-hospital and 1-year outcomes for 337 HIV-infected and HIV-exposed uninfected inpatients not previously enrolled in HIV care were analyzed to assess the clinical influence of each testing strategy.

Results: During BIPAI-PITC, a greater proportion of all hospitalized children received HIV testing (81.0% vs. 33.3%, P < 0.001), accessed inpatient HIV-trained care (7.5% vs. 2.4%, P < 0.001), enrolled into an outpatient HIV clinic after discharge (3.2% vs. 1.3%, P < 0.001), and initiated antiretroviral therapy (ART) after hospitalization (1.1% vs. 0.6%, P = 0.010) compared with NRT. Additionally, BIPAI-PITC increased the proportion of hospitalized HIV-infected and HIV-exposed uninfected children receiving DNA polymerase chain reaction testing (73.5% vs. 35.2%, P < 0.001), but did not improve outpatient enrollment or ART initiation of identified HIV-infected patients.

Conclusions: BIPAI-PITC increases access to inpatient and outpatient pediatric HIV care for hospitalized children, including DNA polymerase chain reaction testing and ART. Broader implementation of BIPAI-PITC or similar approaches, along with more pediatric HIV-trained clinicians and improved defaulter-tracking methods, would improve pediatric HIV service utilization globally.

From the *Baylor International Pediatric AIDS Initiative, Baylor College of Medicine, Lilongwe, Malawi; †Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi; ‡UNC Project, Lilongwe, Malawi; §Interdepartmental Program in Translational Biology and Molecular Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX; ¶Baylor College of Medicine-Children's Foundation, Lilongwe, Malawi; ∥University of North Carolina School of Medicine, Chapel Hill, NC; and **Baylor International Pediatric AIDS Initiative, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.

Accepted for publication January 13, 2011.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Supported by The Baylor International Pediatric AIDS Initiative, which receives primary funding from Bristol Myers Squibb, Abbott Fund, Texas Children's Hospital, United Nations Children's Fund, and the Malawi Ministry of Health. Also, supported in part by the National Institutes of Health (R24 TW007988) through the Fogarty International Center and International Clinical Research Fellows Program at Vanderbilt University and the University of North Carolina Center for AIDS Research (5 P30-AI50410).

Address for correspondence: Eric D. McCollum, MD, Pediatric Department, Kamuzu Central Hospital, University of North Carolina Project, Private Bag A104, Lilongwe, Malawi. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.