Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA.
Partners in Hope Medical Center, Lilongwe, Malawi.
J Acquir Immune Defic Syndr. 2018 Nov 1;79(3):352-357. doi: 10.1097/QAI.0000000000001804.
To meet global AIDS goals, pediatric HIV diagnosis must be strengthened. Provider-initiated testing and counseling, which is recommended by the WHO, faces persistent implementation challenges in low-resource settings. Alternative approaches are needed.
Malawi has achieved high coverage of HIV diagnosis and treatment, but there are gaps among pediatric populations. This study assessed the sensitivity and specificity of a brief screening tool to identify at-risk pediatric patients for targeted HIV testing in Malawi.
A tool containing 6 yes/no items was used for children (aged 1-15 years) in the inpatient pediatric wards at 12 hospitals in Malawi (July 2016-July 2017). Questions were based on an established tool, translated to Chichewa, and implemented by HIV diagnostic assistants. All participating children were provided HIV testing and counseling per Ministry of Health guidelines. Analysis estimated the tool's characteristics including sensitivity, specificity, negative, and positive predictive values.
HIV prevalence among the 8602 participants was 1.1% (n = 90). Children with a screening tool score of 1 had double the odds of being HIV positive than those with a score of 0. Frequent sickness was the most sensitive predictor of HIV status (55.1%), and having a deceased parent was the most specific (96.7%). False classification of HIV-negative status was rare (n = 14) but occurred more often among boys and younger children.
A brief screening tool for pediatric inpatients helped target HIV testing in those most at risk in a low-pediatric-prevalence, resource-constrained setting. Future research should include a direct, rigorous comparison with PITC including comparative effectiveness, efficiency, and cost effectiveness.
为了实现全球艾滋病防治目标，必须加强儿童艾滋病诊断工作。世卫组织建议采用医护人员主动提供艾滋病检测咨询服务，但在资源匮乏的环境中，这种方法的实施仍面临持续挑战。因此，需要采取其他替代方法。
马拉维已实现艾滋病诊断和治疗的高覆盖率，但儿童群体中仍存在差距。本研究评估了一种简短筛查工具在马拉维识别有针对性的儿童艾滋病检测高危人群的敏感性和特异性。
2016 年 7 月至 2017 年 7 月，该工具在马拉维 12 家医院的住院儿科病房中用于 1-15 岁的儿童（n=8602）。问题基于既定的工具，翻译成契恰瓦语，并由艾滋病毒诊断助理实施。所有参与的儿童均按照卫生部的指南提供艾滋病毒检测和咨询。分析评估了该工具的特征，包括敏感性、特异性、阴性和阳性预测值。
8602 名参与者中 HIV 感染率为 1.1%（n=90）。筛查工具得分为 1 的儿童感染 HIV 的可能性是得分为 0 的儿童的两倍。经常生病是 HIV 状态最敏感的预测指标（55.1%），父母一方去世是最特异的指标（96.7%）。HIV 阴性的假阳性结果很少见（n=14），但更多见于男孩和年幼的儿童。
针对儿科住院患者的简短筛查工具有助于在资源匮乏、儿童感染率低的环境中针对高危人群进行 HIV 检测。未来的研究应包括与主动提供艾滋病检测咨询服务的直接、严格比较，包括比较有效性、效率和成本效益。
