PREVALENCE OF HIV INFECTION AMONG CHILDREN SEEN AT FEDERAL MEDICAL CENTRE IDO-EKITI USING PROVIDER INITIATED TESTING AND COUNSELLING STRATEGY

Abstract

Ninety-one percent of global Human Immunodeficiency Virus (HIV) infection in
children occurs in sub-Saharan Africa where it accounts for about 72% of deaths due to Acquired
Immuno Deficiency Syndrome (AIDS). Most people with HIV infection visit healthcare
facilities, yet they are not tested. These are missed opportunities for early diagnosis. Provider
Initiated Testing and Counselling (PITC) Strategy has the potential for early detection of HIV
infection in individuals who visit healthcare facilities. The present study aimed at determining
the acceptability of HIV testing using the PITC Strategy. The prevalence, clinical features and
stages of HIV infection in the children were documented.
Consecutive new patients from birth to age of 15 years who presented at the Paediatric
Emergency Unit of FMC, Ido-Ekiti during the study period were offered HIV testing. Those who
had already been diagnosed or were being treated for HIV infection were excluded. All the
patients were clinically evaluated before the HIV test was done. Patients were examined for
signs of HIV infection based on the revised WHO Paediatric Clinical Staging of HIV/AIDS
Disease.
Serial algorithm testing for HIV infection using Determine HIV-1/2 and Uni-Gold rapid
test kits was adopted. Seropositive patients younger than eighteen months had HIV
Deoxyribonucleic Acid Polymerase Chain Reaction (HIV DNA PCR) test for confirmation.
Of the 543 patients that were counselled for HIV testing, 530 gave consent giving an
acceptance rate of 97.6%. The 530 patients consisted of 296 (55.8%) males and 234 (44.2%)
females, giving a male: female ratio of 1.3: 1. Twenty-four (4.5%) of the 530 patients were
confirmed to have HIV infection; an overall prevalence rate of 4.5%. The age of the 24 patients
with HIV infection ranged between five and 156 months. Fifteen (62.5%) were females and nine
(37.5) males. Of the 24 children with HIV infection, 19 (79.2%) were below 18 months of age.
The most likely route of infection was Mother-To-Child-Transmission in 22 children.
Common symptoms in children with HIV infection were fever, diarrhoea, fast breathing,
cough, and poor weight gain/failure to thrive in 23 (95.8%), 13 (54.2%), 9 (37.5%), 11 (45.8%),
and 10 (41.7%) respectively; these symptoms were significantly more common in patients with
HIV infection than patients without HIV infection. Common signs in patients with HIV infection
were pallor, oral thrush, generalized lymphadenopathy, otorrhoea, hepatomegaly, splenomegaly
and skin lesions in 19 (79.2%), six (25.0%), 23 (95.8%), three (12.5%), 18 (75.0%), 15 (62.5%),
and 12 (50.0%) respectively; these signs were also significantly more common in patients with
HIV infection than patients without HIV infection. Only the presence of poor weight gain and
generalised lymphadenopathy were independent predictors of HIV infection (p < 0.006).
Fourteen (58.3%) and 10 (41.7%) of the 24 patients presented in clinical stages III-IV and
clinical stages I-II respectively. Twelve (50.0%) of the 24 patients had severe immunodeficiency;
with a strong association between immune status and clinical stages.
The present study showed a very high acceptability for testing for HIV infection using the
PITC Strategy. The strategy detected seven (29.2%) of the patients with HIV infection without
significant to mild immunodeficiency. The use of PITC Strategy in healthcare facilities as a
means of early identification of children with HIV infection is therefore highly recommended.

PREVALENCE OF HIV INFECTION AMONG CHILDREN SEEN AT FEDERAL MEDICAL CENTRE IDO-EKITI USING PROVIDER INITIATED TESTING AND COUNSELLING STRATEGY