Integration of PITC for Pediatric Inpatients in Uganda: Challenges and Lessons Learned

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Integration of PITC for Pediatric Inpatients in
Uganda Challenges and Lessons Learned

• Dr. Rhoda Wanyenze
• CT Meeting, January 22nd 2008
• Lusaka, Zambia

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Outline

• Background
• PITC for children
• Results
• Challenges
• Conclusions
• Recommendations

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Background (1)

• ½ of children born to HIV ve mothers die in
  absence of ART, before 2 yrs
• Children often left out testing programs
• Technology
• Testing policies
• Limited skills for handling children
• Mulago Mbarara initiated PITC on Paediatric
  wards, March 2005

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Background (2)

• Mulago and Mbarara are large University teaching
  hospitals in Uganda
• 5 Paediatric wards
• Over 1,000 children seen every month
• Have expanded testing to five regional referral
  hospitals
• Prior to introduction of PITC less than 1 of
  children ever tested for HIV

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PITC for Children

• Initiated by health care providers
• All parents/care givers offered CT using opt-out
  approach
• Irrespective of childs presenting illness
• Children tested if mother is HIV positive, died
  or child suspected to be infected mother is not
  present

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Consent Process

• Based on revised Uganda policy guidelines
• Children above 12 years can be tested without
  parental consent in a VCT setting
• In PITC
• Children aged less than 12 years parents or
  guardians consent
• Children above 12 years consent by parents/
  guardians and assent by children

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HIV Testing

• Rapid tests, same day results children above
  18months
• DNA PCR Children less than 18 months
• Test done by Lab techs or nurses/ other providers
  depending on site
• Rapid tests by nurses/ other providers
• PCR samples taken by lab techs
• Results disclosed to parents children as
  appropriate
• Also placed in the patient files
• HIV care initiated on the wards

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HIV prevalence among caregivers
Uptake of testing for care givers 97 Overall
HIV seroprevalence among care givers 18
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HIV Prevalence Among Pediatric Patients
Acceptance to test children 96 Overall HIV
seroprevalence among children was 11
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HIV Prevalence Among Children of Patients
Children of index HIV positive adult patients
also tested
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Challenges

• Late stage of diagnosis - 60 eligible for ART
  on diagnosis
• Limited contact time for testing mother and then
  child
• Determining age when children can be counseled
  and receive results separately
• Process of disclosure and messages
• Disclosure of positive results when mother is
  absent
• Large numbers with limited personnel
• Sustainability of supplies

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Conclusions

• PITC for hospitalized children and care givers is
  feasible
• Identifies infected children and
  parents/caregivers

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Recommendations

• Empower providers to offer Paediatric CT
• Skills to offer counseling and disclose results,
  assess childrens understanding and readiness for
  counseling
• Need to
• Integrate CT for children at other levels (e.g.
  immunization and other clinics) for early
  diagnosis
• Provide more guidance on messages disclosure
• Innovative ways of alleviating staffing
  challenges

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Acknowledgements

• PEPFAR/CDC
• Ministry of Health
• Mulago Hospital
• Mbarara Hospital
• Regional Hospitals
• MU- Faculty of Medicine
• Other partners
• MJAP Staff

Mother excited about HIV negative results