A study to assess adherence to HIV testing guidelines among HIV exposed paediatric inpatients at Princess Marina Hospital, Gaborone, Botswana

Abstract

Background: Despite well-established prevention of mother to child transmission (PMTCT) programmes, Human Immunodeficiency Virus (HIV) infected children still get missed and present late for diagnosis and antiretroviral therapy (ART). Botswana’s HIV testing guidelines recommend using deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) as early as four weeks old. Timely HIV testing will improve early infant diagnosis (EID). Objectives: To determine the percentage of children under the age of five years that were HIV exposed at birth ,who got admitted to Princess Marina hospital (PMH) at paediatric medical ward (PMW) and paediatric surgical ward (PSW) with a documented HIV test at four to eight weeks and at 17-24 months of age which would indicate testing according to national HIV testing guidelines. This data will be compared to the national testing rate. Methods: This was a clinical audit of 139 HIV exposed inpatients under the age of five years who were, admitted to PMH paediatric wards(PSW and PMW) from 1st March 2019 to 15th August 2019. The HIV testing rates of the cohort at 4-8 weeks and at 17-24 months before admission was assessed and compared to the national HIV testing rates. The proportion of children who were tested before admission and the proportion of those without a prior HIV test who were tested in the hospital was determined. Among the enrolled cohort, baseline characteristics, caregiver characteristics and testing between the two wards were compared for those with a documented test and those without a documented test. Caregiver characteristics were also assessed for association to testing. Results: One hundred and thirty-nine(139) participants were enrolled for the study. The HIV testing rates for the admitted cohort was 6% less for the six weeks testing and 21% less for 18 months testing compared to the national HIV testing rate. Twenty-seven (19.4%) of the admitted cohort did not have a documented HIV test, and the majority 23 (85%) of them got tested in the wards. More participants were tested in paediatric medical ward (PMW) compared to paediatric surgical ward (PSW) but with no statistical significance (p = 0.144). Outcome of ward HIV testing was as follows: 17 (77%) – negative, three (14%) – positive, one (4.5%) – pending, one (4.5%) – had missing results. The majority of participants (79%) had Deoxyribonucleic Acid-Polymerase Chain Reaction (DNA-PCR) test at more than two months of age. No associations between caregiver characteristics and DNA-PCR testing was found. Thirty-six(26%) had no documentation of HIV exposure or status in the under-five child welfare card. Conclusions: This study shows a lower HIV testing rate within the sick cohorts with known exposure at birth compared to the national HIV testing rate. More emphasis on testing paediatric inpatients is needed to improve HIV testing rates and outcomes.