Failure to test children of HIV‐infected mothers in South Africa: implications for HIV testing strategies for preschool children

• Published in: Tropical medicine & international health 2011-12, Vol.16 (12), p.1490-1494
• Main Authors: Chhagan, Meera K., Kauchali, Shuaib, Arpadi, Stephen M., Craib, Murray H., Bah, Fatimatou, Stein, Zena, Davidson, Leslie L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Afrique du Sud; Aged; Aged, 80 and over; Biological and medical sciences; caregivers; Caregivers - psychology; Child; Child, Preschool; cuidadores; dépistage du VIH; enfants d’âge préscolaire; Female; General aspects; Health Knowledge, Attitudes, Practice; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Seroprevalence; HIV testing; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; madres; Mass Screening - statistics & numerical data; Medical sciences; Medical screening; Middle Aged; mothers; Mothers - psychology; mères; niños en edad preescolar; Preschool children; prueba del VIH; soignants; South Africa; South Africa - epidemiology; Sudáfrica; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2011.02872.x

Summary Objectives  To assess the uptake of HIV testing among preschool children with HIV‐positive mothers in a peri‐urban population‐based study in KwaZulu‐Natal, South Africa, an area of high HIV prevalence. Methods  All children 4–6 years old and their primary caregivers from the area were invited to participate. All participants were asked about prior HIV testing and were offered counselling and voluntary HIV testing irrespective of previous testing. Twenty‐seven HIV‐infected mothers were interviewed to identify barriers to testing their children. Results  One thousand five hundred and eighty‐three children (88% of eligible children) and their caregivers participated. Of the biological mothers, 86% were previously tested for HIV (27% tested positive). Among the surviving 244 children born to an infected mother, only 41% had been tested for HIV (23% tested positive). Subsequently, 90% of previously untested children of infected mothers underwent HIV testing (9.3% were positive). Overall seroprevalence among study children was 4.9%. All infected mothers interviewed endorsed the belief that children of HIV‐infected women should be tested for HIV. Women who missed opportunities for antenatal HIV testing reported no systematic testing of their children at later ages. Conclusions  In this community with high HIV prevalence, HIV testing of children is infrequent despite high testing coverage among caregivers. The low proportion of children tested for HIV, particularly those of infected mothers, is of great concern as they are at high risk for morbidity and mortality associated with untreated childhood HIV infection. HIV testing programs should strengthen protocols to include children, especially for those who missed PMTCT opportunities in infancy. Objectifs:  Evaluer l’adoption du dépistage du VIH chez les enfants d’âge préscolaire avec des mères séropositives dans une étude basées sur la population périurbaine dans le KwaZulu‐Natal (KZN), en Afrique du Sud, une zone à forte prévalence du VIH. Méthodes:  Tous les enfants de quatre à six ans de la région et leurs principaux soignants ont été invités à participer. Tous les participants ont été interrogés sur un éventuel dépistage précédent du VIH et ont reçu des conseils et dépistage volontaire du VIH, indépendamment du test précédent. 27 mères infectées par le VIH ont été interrogées afin d’identifier les obstacles au dépistage de leurs enfants. Résultats:  1583 enfants (88% des enfants éligibles) et leurs soi