Document Detail


Performance of the integrated management of childhood illness algorithm for diagnosis of HIV-1 infection among African infants.
MedLine Citation:
PMID:  22824627     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AIDS (London, England)     Volume:  26     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-20     Completed Date:  2013-03-04     Revised Date:  2013-04-25    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  1935-41     Citation Subset:  IM; X    
Affiliation:
Department of Global Health, University of Washington, Seattle, Washington, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
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:
0/Anti-HIV Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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