Improved access to paediatric HIV diagonosis and care by use of an oral fluid rapid test among children less than 18months of age in Lusaka, Zambia
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Background Zambia is a resource constrained country with a Human Immunodeficiency Virus (HIV) prevalence of 16% among adults aged 15-49 years. The HIV sero prevalence in urban antenatal clinics is approximately 25% and it is estimated that 28,000 infants are born with HIV infection annually. Prevalence among antenatal attendees in Lusaka is about 20%, and one out of five infants born in Lusaka is perinatally HIV exposed. The University Teaching Hospital (U.T.H) continues to see an increase in the number of HIV infected infants and young children. In the context of the global effort to scale up paediatric HIV care, the Zambian government through the Ministry of Health introduced "Provider initiated HIV testing and counselling" (PITC) in all health facilities in 2006. UTH, the largest tertiary institution in Zambia and its Department of Paediatrics has pioneered this initiative. Health care providers are offering all paediatric in-patients PITC. Results since 2006 indicate over 85% acceptance among care givers. A non-invasive, rapid HIV test could further increase accessibility of HIV diagnosis among children in resource-poor settings. The use of oral fluid to screen for HIV infection in adults is well established. However, few performance data exist among infants and young children worldwide. The objective of this study was to determine the sensitivity and specificity of an oral fluid HIV test compared to standard blood-based HIV rapid tests, and to assess the acceptability of using oral fluid testing among caregivers of children younger than age 18 months. Methods: Children aged 1 day to 18 months admitted to the U.T.H Department of Paediatrics in Lusaka, Zambia between December 2006 and March 2007 were recruited for this study. Oral fluid and finger prick blood specimens were collected and the serostatus of the children was established using a serial algorithm composed of: Abbott Determine HIV-1/2 and Genie II HIV-1/2 with discordant results resolved using a tie breaker, Bionor. The characteristic of the OraQuick rapid HIV-1/2 assay test was assessed against the established serostatus of the specimens. Results: Of the 1000 children tested in the study, 270 (27 %) were found to have HIV antibodies. The oral fluid, OraQuick detected HIV antibodies among children less than 18 months of age with 100% sensitivity (95% CI: 97.7-99.9) and 98.9% specificity (95% CI: 97,2-99.2); with a positive predictive value of 97.1% (95% CI: 92.8-97.9). Caregiver preference for oral fluid testing increased from 1% before the start of the testing to 81% after the testing experience (p<0.001). Conclusions: The oral fluid rapid test was found to be a highly accurate and acceptable method of screening for HIV antibodies in children younger than 18 months of age. This test has the potential to increase acceptability of HIV screening in infants and young children in resource-limited settings. The high rate of detection of HIV antibodies in infants also underscores the need to expand access to viral detection assays for diagnosis of HIV infection infants.