Cohn, J., Whitehouse, K., Tuttle, J., Lueck, K., and Tran, T. The Lancet (August 2016), doi:10.1016/S2352-3018(16)30050-9.
This systematic review (2004–2016) examined 26 articles on HIV prevalence in children (ages 0–5) identified through screening provided in inpatient, outpatient, nutrition, and immunization settings. Across sites, HIV prevalence was 15.6 percent, with the highest prevalence in inpatient sites, followed by nutrition centers, immunization centers, and then outpatient sites. Symptom-based versus universal testing in inpatient settings trended towards slightly higher HIV prevalence, but findings were not significant. Caregiver acceptance of testing was 92.2 percent. Agreement to testing was often attributed to concerns about the frequency of a child’s illness and a desire to learn a child’s HIV status; reasons for rejecting a test included anxiety about a potentially positive result, not being emotionally prepared, and needing to speak with the male partner before testing. Provider-initiated testing and counseling (PITC) was more likely to be provided in inpatient settings; recurrent trainings are needed to maintain PITC uptake. Rationales for not providing PITC included children's young age, severe illness, and being over-burdened with work. Inpatient settings had the highest retention in care as measured by parents returning for test results. The authors concluded that pediatric health services, outside the prevention of mother-to-child transmission context, represent an important avenue for identifying HIV-positive children, especially in settings that provide inpatient and nutrition services.