Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes
Abstract Introduction To improve the diagnosis and survival of children living with HIV (CLWH), the World Health Organization recommends testing approaches beyond traditional infant HIV testing programmes. Information about undiagnosed HIV prevalence among children of varying ages in the general pop...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-12-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26045 |
| _version_ | 1797976213021523968 |
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| author | Nicole C. McCann Tijana Stanic Martina Penazzato Clare F. Flanagan Elaine J. Abrams Caitlin M. Dugdale Leigh F. Johnson Anne M. Neilan Mary‐Ann Davies Kenneth A. Freedberg Patricia Fassinou Meg Doherty Shaffiq Essajee Angela Mushavi Djøra I. Soeteman Andrea L. Ciaranello |
| author_facet | Nicole C. McCann Tijana Stanic Martina Penazzato Clare F. Flanagan Elaine J. Abrams Caitlin M. Dugdale Leigh F. Johnson Anne M. Neilan Mary‐Ann Davies Kenneth A. Freedberg Patricia Fassinou Meg Doherty Shaffiq Essajee Angela Mushavi Djøra I. Soeteman Andrea L. Ciaranello |
| author_sort | Nicole C. McCann |
| collection | DOAJ |
| description | Abstract Introduction To improve the diagnosis and survival of children living with HIV (CLWH), the World Health Organization recommends testing approaches beyond traditional infant HIV testing programmes. Information about undiagnosed HIV prevalence among children of varying ages in the general population is needed to guide innovative national/subnational case‐finding and testing approaches. Methods We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐Pediatric model to estimate the prevalence of undiagnosed HIV in 2‐, 5‐ and 10‐year‐old children in South Africa, Côte d'Ivoire and Zimbabwe in 2018. We simulated cohorts of children born in 2008 (10‐year‐olds), 2013 (5‐year‐olds) and 2016 (2‐year‐olds). Country‐/year‐specific inputs for pregnant/breastfeeding women included: HIV prevalence (4.2–32.3%), HIV incidence (0.03–0.24%/month), knowledge of HIV status (27–89%) and antiretroviral drug coverage (36–95%). Paediatric inputs included early infant testing coverage (6–95%) and breastfeeding duration (0–20 months). We projected the proportion of surviving CLWH in whom HIV remained undiagnosed and the undiagnosed HIV prevalence among surviving children of each age in the general population. For children born in 2016, we projected survival and diagnosis of all CLWH through 2026. We conducted sensitivity analyses on model parameters. Results In 2018, the projected proportion of surviving CLWH whose HIV remained undiagnosed in South Africa/Côte d'Ivoire/Zimbabwe was 44.2%/55.8%/52.9% among 2‐year‐old CLWH; 29.0%/37.8%/33.2% among 5‐year‐old CLWH; and 18.3%/25.4%/23.1% among 10‐year‐old CLWH. Projected general population undiagnosed HIV prevalence in South Africa/Côte d'Ivoire/Zimbabwe was 0.44%/0.32%/0.68% among 2‐year‐olds; 0.25%/0.17%/0.41% among 5‐year‐olds; and 0.24%/0.14%/0.38% among 10‐year‐olds. Among all CLWH born in 2016, 50–54% were projected to die without HIV diagnosis (and subsequently without treatment) within 10 years after birth; 80–85% of these deaths occurred in the first 2 years. Conclusions Projected population‐level undiagnosed HIV prevalence is low and sharply decreases after age 2, with more CLWH dying than being diagnosed. Despite low undiagnosed prevalence in the general population of older children, we project that a large proportion of CLWH remain undiagnosed, suggesting that innovative strategies targeting untested children of all ages outside of health facility settings should be prioritized. Programmes could consider routine testing of the general population of children below 2 in all settings and children of all ages in high‐prevalence settings. |
| first_indexed | 2024-04-11T04:47:30Z |
| format | Article |
| id | doaj.art-2c4e62e9ee9f4c6398d66be55b92cf3e |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-04-11T04:47:30Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-2c4e62e9ee9f4c6398d66be55b92cf3e2022-12-27T08:56:29ZengWileyJournal of the International AIDS Society1758-26522022-12-012512n/an/a10.1002/jia2.26045Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmesNicole C. McCann0Tijana Stanic1Martina Penazzato2Clare F. Flanagan3Elaine J. Abrams4Caitlin M. Dugdale5Leigh F. Johnson6Anne M. Neilan7Mary‐Ann Davies8Kenneth A. Freedberg9Patricia Fassinou10Meg Doherty11Shaffiq Essajee12Angela Mushavi13Djøra I. Soeteman14Andrea L. Ciaranello15Medical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USAMedical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USAGlobal HIV Hepatitis and STI Programme World Health Organization Geneva SwitzerlandMedical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USAICAP at Columbia University Mailman School of Public Health Columbia University New York USAMedical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USACentre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town Cape Town South AfricaMedical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USACentre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town Cape Town South AfricaMedical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USAElizabeth Glaser Pediatric AIDS Foundation Abidjan Côte d'IvoireGlobal HIV Hepatitis and STI Programme World Health Organization Geneva SwitzerlandUNICEF New York USAMinistry of Health and Child Care Harare ZimbabweMedical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USAMedical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USAAbstract Introduction To improve the diagnosis and survival of children living with HIV (CLWH), the World Health Organization recommends testing approaches beyond traditional infant HIV testing programmes. Information about undiagnosed HIV prevalence among children of varying ages in the general population is needed to guide innovative national/subnational case‐finding and testing approaches. Methods We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐Pediatric model to estimate the prevalence of undiagnosed HIV in 2‐, 5‐ and 10‐year‐old children in South Africa, Côte d'Ivoire and Zimbabwe in 2018. We simulated cohorts of children born in 2008 (10‐year‐olds), 2013 (5‐year‐olds) and 2016 (2‐year‐olds). Country‐/year‐specific inputs for pregnant/breastfeeding women included: HIV prevalence (4.2–32.3%), HIV incidence (0.03–0.24%/month), knowledge of HIV status (27–89%) and antiretroviral drug coverage (36–95%). Paediatric inputs included early infant testing coverage (6–95%) and breastfeeding duration (0–20 months). We projected the proportion of surviving CLWH in whom HIV remained undiagnosed and the undiagnosed HIV prevalence among surviving children of each age in the general population. For children born in 2016, we projected survival and diagnosis of all CLWH through 2026. We conducted sensitivity analyses on model parameters. Results In 2018, the projected proportion of surviving CLWH whose HIV remained undiagnosed in South Africa/Côte d'Ivoire/Zimbabwe was 44.2%/55.8%/52.9% among 2‐year‐old CLWH; 29.0%/37.8%/33.2% among 5‐year‐old CLWH; and 18.3%/25.4%/23.1% among 10‐year‐old CLWH. Projected general population undiagnosed HIV prevalence in South Africa/Côte d'Ivoire/Zimbabwe was 0.44%/0.32%/0.68% among 2‐year‐olds; 0.25%/0.17%/0.41% among 5‐year‐olds; and 0.24%/0.14%/0.38% among 10‐year‐olds. Among all CLWH born in 2016, 50–54% were projected to die without HIV diagnosis (and subsequently without treatment) within 10 years after birth; 80–85% of these deaths occurred in the first 2 years. Conclusions Projected population‐level undiagnosed HIV prevalence is low and sharply decreases after age 2, with more CLWH dying than being diagnosed. Despite low undiagnosed prevalence in the general population of older children, we project that a large proportion of CLWH remain undiagnosed, suggesting that innovative strategies targeting untested children of all ages outside of health facility settings should be prioritized. Programmes could consider routine testing of the general population of children below 2 in all settings and children of all ages in high‐prevalence settings.https://doi.org/10.1002/jia2.26045Africa < regionHIV care continuummodellingpaediatricstestingvertical transmission |
| spellingShingle | Nicole C. McCann Tijana Stanic Martina Penazzato Clare F. Flanagan Elaine J. Abrams Caitlin M. Dugdale Leigh F. Johnson Anne M. Neilan Mary‐Ann Davies Kenneth A. Freedberg Patricia Fassinou Meg Doherty Shaffiq Essajee Angela Mushavi Djøra I. Soeteman Andrea L. Ciaranello Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes Journal of the International AIDS Society Africa < region HIV care continuum modelling paediatrics testing vertical transmission |
| title | Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes |
| title_full | Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes |
| title_fullStr | Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes |
| title_full_unstemmed | Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes |
| title_short | Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model‐based analysis to inform paediatric HIV screening programmes |
| title_sort | prevalence of undiagnosed hiv among children in south africa cote d ivoire and zimbabwe a model based analysis to inform paediatric hiv screening programmes |
| topic | Africa < region HIV care continuum modelling paediatrics testing vertical transmission |
| url | https://doi.org/10.1002/jia2.26045 |
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