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Development of a clinical algorithm to prioritise HIV testing of hospitalised paediatric patients in a low resource moderate prevalence setting
  1. Waridibo E Allison1,
  2. Mobumo Kiromat2,
  3. John Vince3,
  4. Handan Wand1,
  5. Philip Cunningham4,
  6. Stephen M Graham5,
  7. John Kaldor1
  1. 1National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, Sydney, Australia
  2. 2William J Clinton Foundation, Port Moresby, Papua New Guinea
  3. 3Clinical Sciences Division, School of Medicine and Health Sciences, University of Papua New Guinea. Port Moresby, Papua New Guinea
  4. 4Department of Molecular Diagnosis, NSW State Reference Laboratory for HIV/AIDS, St Vincent's Hospital, Sydney, Australia
  5. 5Centre for International Child Health, Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
  1. Correspondence to Dr Waridibo E Allison, NCHECR, University of New South Wales, Sydney NSW 2052, Australia; wallison{at}


Objective To develop a clinical algorithm to identify paediatric patients who should be offered HIV testing in a setting of moderate HIV prevalence and limited resources.

Methods In a prospective cross-sectional study at Port Moresby General Hospital, Papua New Guinea, carers of inpatients were offered HIV testing and counselling for their children. Recruited children were tested for HIV antibodies and DNA. Standardised clinical information was collected. Multivariate regression analysis was used to ascertain independent predictors of HIV infection and these were used to develop a predictive algorithm.

Results From September 2007 to October 2008, 487 children were enrolled. Overall, 55 (11%) with a median age of 7 months were found to be HIV-infected. In multivariate analysis, independent predictors of HIV infection were: persistent fever (OR = 2.05 (95% CI 1.11 to 4.68)), lymphadenopathy (OR = 2.29 (1.12 to 4.68)), oral candidiasis (OR = 3.94 (2.17 to 7.14)) and being underweight for age (OR = 2.03 (1.03 to 3.99)). The presence of any one of these conditions had a sensitivity of 96% in detecting a child with HIV infection. Using an algorithm based on the presence of at least one of these conditions would result in around 40% of hospitalised children being offered testing.

Conclusions This clinical algorithm may be a useful screening tool for HIV infection in hospitalised children in situations where it is not feasible to offer universal HIV testing, providing guidance for HIV testing practices for increased identification and management of HIV-infected children in Papua New Guinea.

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  • Funding This study was funded by a National AIDS Council Secretariat (Papua New Guinea) Research Award. NCHECR is funded by the Australian Government Department of Health & Ageing.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Medical Research Advisory Committee, Papua New Guinea, and the University of New South Wales Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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