205811 Low rates of HIV testing among high risk children living in semi-rural communities with high HIV prevalence in KwaZulu-Natal, RSA

Tuesday, November 10, 2009

Meera Chhagan, MBchB, PhD, DCH , Department of Paediatrics & Child Health, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban, South Africa
Shuaib Kauchali, MBchB, MPhil, DC , Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban 4001, South Africa
Marelize Bosman, MBChB, DCH (SA) , Nelson R Mandela School of Medicine, Durban, South Africa
Stephen Arpadi, MD, MS , College of Physicians & Surgeons, Mailman School of Public Health, Columbia University, New York, NY
Jane Kvalsvig, PhD , Nelson R Mandela School of Medicine, Durban, South Africa
Miriam Adhikari, MBchB , Nelson R Mandela School of Medicine, Durban, South Africa
Claude Mellins, PhD , NYState Psychiatric Institute and Columbia University, HIV Center for Clinical and Behavioral Studies, New York, NY
Leslie L. Davidson, MD, MSc , Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
Background: In high prevalence, generalized epidemics, routine HIV testing at health facilities and community base settings is critical in order to identify individuals who can benefit from treatment and for reduction of further transmission. Few surveys have described the uptake of HIV testing on a household level, especially among children in areas with high HIV seroprevalence.

Methods: We describe preliminary findings from a population-based epidemiologic study of health and psychosocial needs of preschool children aged 4-6 conducted in KwaZulu-Natal, RSA.

Results: A survey of 1800 households that identified 207 preschool children was conducted during spring 2008. Of the 160 children and caregivers assessed thus far, the primary caregiver was the mother in 97/160 (61%), the father in 3 (2%), the grandmother in 31(19%), a sibling in 5 (3%), and another relative in 12%. 92/160 (57.5%) caregivers reported having been tested for HIV previously and 89 (97%) reported knowing their results. The prevalence of HIV in these caregivers was 29/89 (33%) of whom 11 (38%) were already on antiretroviral therapy. Prior HIV testing information was available for 151 children, of whom only 18 (12%) were previously tested. Only 6/24 (25%) children of HIV Infected mothers had undergone HIV testing.

Conclusion: In this survey of households conducted in a community with high HIV prevalence, knowledge of HIV status is low especially among children. HIV testing strategies should be strengthened. Policies that facilitate consent for HIV testing by non parental caregivers in a manner that protects the rights of the child are required.

Learning Objectives:
1.To examine challenges in determining HIV status in children, particularly children of infected mothers. 2. To examine issues related to obtaining consent for HIV testing for children by non-parental caregivers. 3. To brainstorm strategies for adapting effective systems for HIV testing of children in high prevalence areas.

Keywords: Children's Health, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a professor of Epidemiology and of Pediatrics at Columbia University. I am the PI for the NIDA funded study in South Africa from which the data to be presented is derived. We have a US and a South African team of collaborators who work closely together. My eductational background is an MD from Columbia in 1978, Pediatric training at Columbia from 1978 to 1981, and an MSc in Epidemiology from the London School of Hygiene in 1982. I also had a research scholarship from teh Milbank Foundation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.