Routine inpatient provider-initiated HIV testing in Malawi, compared with client-initiated community-based testing, identifies younger children at higher risk of early mortality

Geoffrey A. Preidis, Eric McCollum, William Kamiyango, Alejandro Garbino, Mina C. Hosseinipour, Peter N. Kazembe, Gordon E. Schutze, Mark W. Kline

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To determine how routine inpatient provider-initiated HIV testing differs from traditional community-based client-initiated testing with respect to clinical characteristics of children identified and outcomes of outpatient HIV care. DESIGN: Prospective observational cohort. METHODS: Routine clinical data were collected from children identified as HIV-infected by either testing modality in Lilongwe, Malawi, in 2008. After 1 year of outpatient HIV care at the Baylor College of Medicine Clinical Center of Excellence, outcomes were assessed. RESULTS: Of 742 newly identified HIV-infected children enrolling into outpatient HIV care, 20.9% were identified by routine inpatient HIV testing. Compared with community-identified children, hospital-identified patients were younger (median 25.0 vs 53.5 months), with more severe disease (22.2% vs 7.8% WHO stage IV). Of 466 children with known outcomes, 15.0% died within the first year of HIV care; median time to death was 15.0 weeks for community-identified children vs 6.0 weeks for hospital-identified children. The strongest predictors of early mortality were severe malnutrition (hazard ratio, 4.3; 95% confidence interval, 2.2-8.3), moderate malnutrition (hazard ratio, 3.2; confidence interval, 1.6-6.6), age <12 months (hazard ratio, 3.2; 95% confidence interval, 1.4-7.2), age 12 to 24 months (hazard ratio, 2.5; 95% confidence interval, 1.1-5.7), and WHO stage IV (hazard ratio, 2.2; 95% confidence interval, 1.1-4.6). After controlling for other variables, hospital identification did not independently predict mortality. CONCLUSIONS: Routine inpatient HIV testing identifies a subset of younger HIV-infected children with more severe, rapidly progressing disease that traditional community-based testing modalities are currently missing.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
Volume63
Issue number1
DOIs
StatePublished - May 1 2013
Externally publishedYes

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Malawi
Inpatients
HIV
Mortality
Confidence Intervals
Ambulatory Care
Malnutrition
Clinical Medicine

Keywords

  • Africa
  • antiretroviral therapy
  • HIV testing
  • Malawi
  • pediatric HIV
  • pediatric hospitals

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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Routine inpatient provider-initiated HIV testing in Malawi, compared with client-initiated community-based testing, identifies younger children at higher risk of early mortality. / Preidis, Geoffrey A.; McCollum, Eric; Kamiyango, William; Garbino, Alejandro; Hosseinipour, Mina C.; Kazembe, Peter N.; Schutze, Gordon E.; Kline, Mark W.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 63, No. 1, 01.05.2013.

Research output: Contribution to journalArticle

Preidis, Geoffrey A. ; McCollum, Eric ; Kamiyango, William ; Garbino, Alejandro ; Hosseinipour, Mina C. ; Kazembe, Peter N. ; Schutze, Gordon E. ; Kline, Mark W. / Routine inpatient provider-initiated HIV testing in Malawi, compared with client-initiated community-based testing, identifies younger children at higher risk of early mortality. In: Journal of Acquired Immune Deficiency Syndromes. 2013 ; Vol. 63, No. 1.
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abstract = "OBJECTIVE: To determine how routine inpatient provider-initiated HIV testing differs from traditional community-based client-initiated testing with respect to clinical characteristics of children identified and outcomes of outpatient HIV care. DESIGN: Prospective observational cohort. METHODS: Routine clinical data were collected from children identified as HIV-infected by either testing modality in Lilongwe, Malawi, in 2008. After 1 year of outpatient HIV care at the Baylor College of Medicine Clinical Center of Excellence, outcomes were assessed. RESULTS: Of 742 newly identified HIV-infected children enrolling into outpatient HIV care, 20.9{\%} were identified by routine inpatient HIV testing. Compared with community-identified children, hospital-identified patients were younger (median 25.0 vs 53.5 months), with more severe disease (22.2{\%} vs 7.8{\%} WHO stage IV). Of 466 children with known outcomes, 15.0{\%} died within the first year of HIV care; median time to death was 15.0 weeks for community-identified children vs 6.0 weeks for hospital-identified children. The strongest predictors of early mortality were severe malnutrition (hazard ratio, 4.3; 95{\%} confidence interval, 2.2-8.3), moderate malnutrition (hazard ratio, 3.2; confidence interval, 1.6-6.6), age <12 months (hazard ratio, 3.2; 95{\%} confidence interval, 1.4-7.2), age 12 to 24 months (hazard ratio, 2.5; 95{\%} confidence interval, 1.1-5.7), and WHO stage IV (hazard ratio, 2.2; 95{\%} confidence interval, 1.1-4.6). After controlling for other variables, hospital identification did not independently predict mortality. CONCLUSIONS: Routine inpatient HIV testing identifies a subset of younger HIV-infected children with more severe, rapidly progressing disease that traditional community-based testing modalities are currently missing.",
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AU - Preidis, Geoffrey A.

AU - McCollum, Eric

AU - Kamiyango, William

AU - Garbino, Alejandro

AU - Hosseinipour, Mina C.

AU - Kazembe, Peter N.

AU - Schutze, Gordon E.

AU - Kline, Mark W.

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AB - OBJECTIVE: To determine how routine inpatient provider-initiated HIV testing differs from traditional community-based client-initiated testing with respect to clinical characteristics of children identified and outcomes of outpatient HIV care. DESIGN: Prospective observational cohort. METHODS: Routine clinical data were collected from children identified as HIV-infected by either testing modality in Lilongwe, Malawi, in 2008. After 1 year of outpatient HIV care at the Baylor College of Medicine Clinical Center of Excellence, outcomes were assessed. RESULTS: Of 742 newly identified HIV-infected children enrolling into outpatient HIV care, 20.9% were identified by routine inpatient HIV testing. Compared with community-identified children, hospital-identified patients were younger (median 25.0 vs 53.5 months), with more severe disease (22.2% vs 7.8% WHO stage IV). Of 466 children with known outcomes, 15.0% died within the first year of HIV care; median time to death was 15.0 weeks for community-identified children vs 6.0 weeks for hospital-identified children. The strongest predictors of early mortality were severe malnutrition (hazard ratio, 4.3; 95% confidence interval, 2.2-8.3), moderate malnutrition (hazard ratio, 3.2; confidence interval, 1.6-6.6), age <12 months (hazard ratio, 3.2; 95% confidence interval, 1.4-7.2), age 12 to 24 months (hazard ratio, 2.5; 95% confidence interval, 1.1-5.7), and WHO stage IV (hazard ratio, 2.2; 95% confidence interval, 1.1-4.6). After controlling for other variables, hospital identification did not independently predict mortality. CONCLUSIONS: Routine inpatient HIV testing identifies a subset of younger HIV-infected children with more severe, rapidly progressing disease that traditional community-based testing modalities are currently missing.

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KW - antiretroviral therapy

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KW - pediatric HIV

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