| Performance of the integrated management of childhood illness algorithm for diagnosis of HIV-1 infection among African infants. | |
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MedLine Citation:
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PMID: 22824627 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Early infant HIV-1 diagnosis and treatment substantially improve survival. Where virologic HIV-1 testing is unavailable, integrated management of childhood illness (IMCI) clinical algorithms may be used for infant HIV-1 screening. We evaluated the performance of the 2008 WHO IMCI HIV algorithm in a cohort of HIV-exposed Kenyan infants. METHODS: From 1999 to 2003, 444 infants had monthly clinical assessments and quarterly virologic HIV-1 testing. Using archived clinical data, IMCI sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using virologic testing as a gold standard. Linear regression and survival analyses were used to determine the effect of age on IMCI performance and timing of diagnosis. RESULTS: Overall IMCI sensitivity, specificity, PPV, and NPV value were 58, 87, 52, and 90%, respectively. Sensitivity (1.4%) and PPV (14%) were lowest at 1 month of age, when 81% of HIV infections already had occurred. Sensitivity increased with age (P < 0.0001), but remained low throughout infancy (range 1.4-35%). Specificity (range 97-100%) was high at each time point and was not associated with age. Fifty-eight percent of HIV-1-infected infants (50 of 86) were eventually diagnosed by IMCI, and use of IMCI was estimated to delay diagnosis in HIV-infected infants by a median of 5.9 months (P < 0.0001). CONCLUSION: IMCI had low sensitivity during the first month of life, when the majority of HIV-1 infections had already occurred and initiation of treatment is most critical. Although sensitivity increased with age, the substantial delay in HIV-1 diagnosis using IMCI limits its utility in early infant HIV-1 diagnosis. |
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Authors:
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Lara C Diener; Jennifer A Slyker; Christine Gichuhi; Kenneth A Tapia; Barbra A Richardson; Dalton Wamalwa; Carey Farquhar; Julie Overbaugh; Elizabeth Maleche-Obimbo; Grace John-Stewart |
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Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: AIDS (London, England) Volume: 26 ISSN: 1473-5571 ISO Abbreviation: AIDS Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-09-20 Completed Date: 2013-03-04 Revised Date: 2013-04-25 |
Medline Journal Info:
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Nlm Unique ID: 8710219 Medline TA: AIDS Country: England |
Other Details:
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Languages: eng Pagination: 1935-41 Citation Subset: IM; X |
Affiliation:
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Department of Global Health, University of Washington, Seattle, Washington, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Algorithms Anti-HIV Agents / administration & dosage* Breast Feeding / statistics & numerical data Candidiasis, Oral / diagnosis*, epidemiology Child Health Services Delivery of Health Care, Integrated Female Guidelines as Topic HIV Infections / diagnosis*, drug therapy, epidemiology HIV-1* Humans Infant Infant, Newborn Infectious Disease Transmission, Vertical / statistics & numerical data* Kenya / epidemiology Lymphatic Diseases / diagnosis*, epidemiology Male Mass Screening Pneumonia / diagnosis*, epidemiology Pregnancy Prevalence Risk Factors Sensitivity and Specificity World Health Organization |
| Grant Support | |
ID/Acronym/Agency:
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K01 AI 087369/AI/NIAID NIH HHS; K01 AI087369/AI/NIAID NIH HHS; K24 HD 054314/HD/NICHD NIH HHS; P30 AI027757/AI/NIAID NIH HHS; R01 HD 23412/HD/NICHD NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents |
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