Prevalence, clinical pattern and immediate outcomes of HIV-infected children admitted to Al Sabah Children’s Hospital, South Sudan

Introduction: HIV continues to be a major global health issue. There were approximately 2.1 million infected children aged <15 years in 2017 and most were in sub-Saharan Africa. South Sudan with its low prevention of mother to child transmission (PMTCT) coverage has a greater risk of high transmission rates of HIV from mothers to their children.Objective: To determine the prevalence of HIV infection, the clinical pattern, and the immediate outcomes of children admitted to Al Sabah Children’s Hospital.Method: This was a cross sectional descriptive study, with a longitudinal component for the immediate outcome. A total of 828 children were recruited: 424 aged <18 months and 424 aged ≥ 18 months. HIV rapid tests were done to confirm the HIV infection for children aged ≥18 months, while HIV DNA-PCR was done to confirm the HIV infection for children aged <18 months found to be HIV exposed.Results: Twenty four children tested HIV positive giving an overall HIV prevalence of 2.8% (95% CI 1.8 – 4.2). The clinical characteristics associated with HIV infection were: a history of cough (p=0.001), weight loss (p <0.001), oral thrush (p <0.001), lymphadenopathy (p=0.001), ear discharge (p <0.001), skin lesion (p <0.001), hepatomegaly (p <0.001), and splenomegaly (p <0.01). Factors associated with prolonged hospital stay were history of weight loss (OR=4.96, 95% CI 2.68-9.18), skin lesions (OR=3.60, 95% CI 1.36-9.56), and weight for height/length z score<-3SD (OR=8.67, 95% CI 4.70-15.99).Conclusion: The prevalence of HIV among this hospital based population of children aged less than 15 years was 2.8%. Children who presented with cough, weight loss, oral thrush, lymphadenopathy, ear discharge, skin lesion, hepatomegaly, and splenomegaly in this setting were likely to have HIV infection and should therefore raise suspicion for testing and early diagnosis.Keywords: HIV infection, clinical characteristics, children, hospital stay, South SudanSouth Sudan Medical Journal Vol 12 No 3 August 201

Depressive symptoms, sexual activity, and substance use among adolescents in Kampala, Uganda

Background: Adolescents experience high rates of depression, initiation of sexual activity, and substance use.Objectives: To better understand the demographics of adolescents presenting to an adolescent clinic in Uganda, and to elucidate which factors are associated with depressive symptoms, sexual initiation, and substance use.Methods: A retrospective review was performed on intake forms obtained during interviews with adolescents presenting to the Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH) in Kampala, Uganda.Results: Depressive symptoms in adolescents were correlated with having a chronic illness (p=.026), and reported poor quality of home life (p<.001). Initiation of sexual activity was also correlated with chronic illness (p=.008) and poor quality of home life (p=.006). Substance use was correlated with maternal death (p=.041), chronic illness (p=.038), and substance use among family members (p<.001) and friends (p<.001).Conclusions: Knowing the aforementioned risk factors can help us better understand the needs of adolescents presenting toMMCAH, and allows us to develop targeted interventions aimed at decreasing health risks in Kampala’s adolescent population.Keywords: Depressive symptoms, sexual activity, substance use, adolescents, Uganda

Xpert MTB/RIF Ultra for Tuberculosis Testing in Children: A Mini-Review and Commentary.

Tuberculosis (TB) remains a significant, yet under-recognized cause of death in the pediatric population, with a WHO estimate of 1 million new cases of childhood TB in 2016 resulting in 250,000 deaths. Diagnosis is notoriously difficult; manifestations are protean due to the high proportion of cases of extra-pulmonary TB in children, and logistical problems exist in obtaining suitable specimens. These issues are compounded by the paucibacillary nature of disease with the result that an estimated 96% of pediatric TB-associated mortality occurs prior to commencing anti-tuberculous treatment. Further development of sensitive, rapid diagnostic tests and their incorporation into diagnostic algorithms is vital in this population, and central to the WHO End-TB strategy. Initial gains were made with the expansion of nucleic acid amplification technology, particularly the introduction of the GeneXpert fully-automated PCR Xpert MTB/Rif assay in 2010, and more recently, the Xpert MTB/Rif Ultra (Ultra) assay in 2017. Ultra provides increased analytical sensitivity when compared with the initial Xpert assay in vitro; a finding now also supported by six clinical studies to date, two of which included pediatric samples. Here, we review the published evidence for the performance of Ultra in TB diagnosis in children, as well as studies in adults with paucibacillary disease providing results relevant to the pediatric population. Following on from this, we speculate upon future directions for Ultra, with focus on its potential use with alternative diagnostic specimens, which may be of particular utility in children

Xpert MTB/RIF Ultra for Tuberculosis Testing in Children: A Mini-Review and Commentary

Tuberculosis (TB) remains a significant, yet under-recognized cause of death in the pediatric population, with a WHO estimate of 1 million new cases of childhood TB in 2016 resulting in 250,000 deaths. Diagnosis is notoriously difficult; manifestations are protean due to the high proportion of cases of extra-pulmonary TB in children, and logistical problems exist in obtaining suitable specimens. These issues are compounded by the paucibacillary nature of disease with the result that an estimated 96% of pediatric TB-associated mortality occurs prior to commencing anti-tuberculous treatment. Further development of sensitive, rapid diagnostic tests and their incorporation into diagnostic algorithms is vital in this population, and central to the WHO End-TB strategy. Initial gains were made with the expansion of nucleic acid amplification technology, particularly the introduction of the GeneXpert fully-automated PCR Xpert MTB/Rif assay in 2010, and more recently, the Xpert MTB/Rif Ultra (Ultra) assay in 2017. Ultra provides increased analytical sensitivity when compared with the initial Xpert assay in vitro; a finding now also supported by six clinical studies to date, two of which included pediatric samples. Here, we review the published evidence for the performance of Ultra in TB diagnosis in children, as well as studies in adults with paucibacillary disease providing results relevant to the pediatric population. Following on from this, we speculate upon future directions for Ultra, with focus on its potential use with alternative diagnostic specimens, which may be of particular utility in children

Making Implementation Science Work for Children and Adolescents Living With HIV.

The global HIV response is leaving children and adolescents behind. Because of a paucity of studies on treatment and care models for these age groups, there are gaps in our understanding of how best to implement services to improve their health outcomes. Without this evidence, policymakers are left to extrapolate from adult studies, which may not be appropriate, and can lead to inefficiencies in service delivery, hampered uptake, and ineffective mechanisms to support optimal outcomes. Implementation science research seeks to investigate how interventions known to be efficacious in study settings are, or are not, routinely implemented within real-world programmes. Effective implementation science research must be a collaborative effort between government, funding agencies, investigators, and implementers, each playing a key role. Successful implementation science research in children and adolescents requires clearer policies about age of consent for services and research that conform to ethical standards but allow for rational modifications. Implementation research in these age groups also necessitates age-appropriate consultation and engagement of children, adolescents, and their caregivers. Finally, resource, systems, technology, and training must be prioritized to improve the availability and quality of age-/sex-disaggregated data. Implementation science has a clear role to play in facilitating understanding of how the multiple complex barriers to HIV services for children and adolescents prevent effective interventions from reaching more children and adolescents living with HIV, and is well positioned to redress gaps in the HIV response for these age groups. This is truer now more than ever, with urgent and ambitious 2020 global targets on the horizon and insufficient progress in these age groups to date