Remembering the Children: Implementation and Success of a Robust Method for Identifying and Testing Children of HIV Patients

Background. Children of HIV patients are a historically neglected demographic by HIV services. It has been recommended by CHIVA that HIV services have a robust method of detecting and testing untested children. We note that no such method is either in widespread use or in the literature. Method. In December 2011, a one-page proforma to identify HIV untested children and a clear multidisciplinary pathway to test them were implemented. Twelve months later the uptake of the proforma and pathway, the numbers of patients and children identified for testing, and their outcomes were audited. Results. The proforma was completed in 192/203 (94.6%) eligible patients. Twenty-five (21.5%) of 118 identified offspring had not been tested. Ten (8.5%) of these were <18 years old. All were reported to be clinically well. Ten children were referred for testing, seven were tested immediately, and three were tested within 18 months of identification. All children were tested HIV negative. Discussion. We have identified a method of identification that is easy and robust and provides a user-friendly safety net to empower healthcare providers to identify and test children at risk. We recommend the implementation of such strategies nationwide to prevent death due to undiagnosed HIV in children. 1. Introduction HIV infection in children is an important public health issue. Although global transmission rates are decreasing, 3.3 million children under the age of 14 are infected with HIV of whom 330,000 contracted the virus in 2011 [1]. In contrast, vertical transmission rates are <1% in the UK due the successful UK antenatal HIV testing program and routine postdelivery HIV testing of all children born to HIV-positive mothers [2]. However, there are still children living in the UK who are HIV-positive without being tested [3] with potentially catastrophic consequences. These are mostly children of mothers who have received their antenatal care outside the UK. Children with HIV may remain asymptomatic until adolescence and early adulthood [4] and therefore present late in their disease. In the period of 2003–2006, 18 children were known to have died from HIV, nine within one month of their HIV diagnosis [5]. In order to prevent HIV associated morbidity and mortality it is important to identify children of HIV-positive patients who have never been HIV tested, regardless of age. The children of HIV patients are a historically poorly captured demographic within UK HIV medicine services [6, 7] for a multitude of reasons.(1)Poor and inconsistent data collection on the children of