AEGiS-15IAC: Pediatric HIV-screening at the level of an African district hospital: An exploratory study.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Pediatric HIV-screening at the level of an African district hospital: An exploratory study.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrB1145)

De Baets A, Edidi B, Beelaert G, Schrooten W, Kolsteren P, Fransen K
Institute of Tropical Medicine, Antwerp, Belgium

BACKGROUND: Phlebotomy and HIV-testing in children at the district hospital level remain complicated in many aspects. Alternative tests and strategies would facilitate optimization of care and scaling up of antiretroviral therapy.

METHODS: Venous and capillar phlebotomies were performed on 941 Congolese children, aged 1 month to 12 years old, for a cross-sectional study. 153 of these children were below 18 months old versus 788 children above 18 months. HIV-prevalence rate was 4,68%. PCR and EIA were used as references and confirmed by viral loads (range: 3,28 -7,19 log copies/ml) in case of HIV-infection.

RESULTS: The algorithm for children above 18 months, using serial rapid tests (determine, instant screen and unigold) on capillar blood stored in EDTA-tubes, had a sensitivity of 100% (95%CI: 88,97-100%) and a specificity of 100% (95%CI: 99,50-100%). The sensitivity of the hypersensitive p-24 Ag-test was 92,31% (95%CI:66,69-98,63%) and 100% (95%CI:56,55-100%) when performed on venous plasma (n=150) versus capillar plasma stored on filter paper (n=87). The specificity was 100% in both cases (95%CI:97,27-100% and 95%CI: 95,52-100% respectively). No needle stick injuries were reported. 89,65% of the children below 18 months and 94,42% of the older children could be correctly diagnosed with only one determine test. Conclusion An algorithm of rapid tests performed on capillar blood provided equivalent results to serial EIA. Use of glucolets instead of syringes and needles may reduce pain and the risk of needle stick injuries at a comparable cost. The results suggest that the hypersensitive p-24 Ag-test can be performed with plasma obtained by finger prick and stored on filter paper. This could simplify transport of samples and facilitate future research, as blood for PCR can be stored on the same card. Although this study population had low HIV-prevalence, the results point to under-utilized opportunities to exclude pediatric HIV.

Keywords: AEGIS, HIV Infections, Prevalence, HIV Seropositivity, Sensitivity and Specificity, Acquired Immunodeficiency Syndrome, Hospitals, District, AIDS Serodiagnosis, Cross-Sectional Studies, Humans, Child, diagnosis, blood

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TuOrB1145