PMID- 36519674 OWN - NLM STAT- MEDLINE DCOM- 20221216 LR - 20230305 IS - 1758-2652 (Electronic) IS - 1758-2652 (Linking) VI - 25 IP - 12 DP - 2022 Dec TI - Prevalence of undiagnosed HIV among children in South Africa, Cote d'Ivoire and Zimbabwe: a model-based analysis to inform paediatric HIV screening programmes. PG - e26045 LID - 10.1002/jia2.26045 [doi] LID - e26045 AB - INTRODUCTION: To improve the diagnosis and survival of children living with HIV (CLWH), the World Health Organization recommends testing approaches beyond traditional infant HIV testing programmes. Information about undiagnosed HIV prevalence among children of varying ages in the general population is needed to guide innovative national/subnational case-finding and testing approaches. METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model to estimate the prevalence of undiagnosed HIV in 2-, 5- and 10-year-old children in South Africa, Cote d'Ivoire and Zimbabwe in 2018. We simulated cohorts of children born in 2008 (10-year-olds), 2013 (5-year-olds) and 2016 (2-year-olds). Country-/year-specific inputs for pregnant/breastfeeding women included: HIV prevalence (4.2-32.3%), HIV incidence (0.03-0.24%/month), knowledge of HIV status (27-89%) and antiretroviral drug coverage (36-95%). Paediatric inputs included early infant testing coverage (6-95%) and breastfeeding duration (0-20 months). We projected the proportion of surviving CLWH in whom HIV remained undiagnosed and the undiagnosed HIV prevalence among surviving children of each age in the general population. For children born in 2016, we projected survival and diagnosis of all CLWH through 2026. We conducted sensitivity analyses on model parameters. RESULTS: In 2018, the projected proportion of surviving CLWH whose HIV remained undiagnosed in South Africa/Cote d'Ivoire/Zimbabwe was 44.2%/55.8%/52.9% among 2-year-old CLWH; 29.0%/37.8%/33.2% among 5-year-old CLWH; and 18.3%/25.4%/23.1% among 10-year-old CLWH. Projected general population undiagnosed HIV prevalence in South Africa/Cote d'Ivoire/Zimbabwe was 0.44%/0.32%/0.68% among 2-year-olds; 0.25%/0.17%/0.41% among 5-year-olds; and 0.24%/0.14%/0.38% among 10-year-olds. Among all CLWH born in 2016, 50-54% were projected to die without HIV diagnosis (and subsequently without treatment) within 10 years after birth; 80-85% of these deaths occurred in the first 2 years. CONCLUSIONS: Projected population-level undiagnosed HIV prevalence is low and sharply decreases after age 2, with more CLWH dying than being diagnosed. Despite low undiagnosed prevalence in the general population of older children, we project that a large proportion of CLWH remain undiagnosed, suggesting that innovative strategies targeting untested children of all ages outside of health facility settings should be prioritized. Programmes could consider routine testing of the general population of children below 2 in all settings and children of all ages in high-prevalence settings. CI - (c) 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. FAU - McCann, Nicole C AU - McCann NC AUID- ORCID: 0000-0003-3266-0065 AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Stanic, Tijana AU - Stanic T AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Penazzato, Martina AU - Penazzato M AUID- ORCID: 0000-0001-5485-8692 AD - Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland. FAU - Flanagan, Clare F AU - Flanagan CF AUID- ORCID: 0000-0002-2425-7690 AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Abrams, Elaine J AU - Abrams EJ AD - ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA. AD - Department of Pediatrics, Vagellos College of Physicians and Surgeons, Columbia University, New York, USA. FAU - Dugdale, Caitlin M AU - Dugdale CM AUID- ORCID: 0000-0002-6604-6111 AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Johnson, Leigh F AU - Johnson LF AUID- ORCID: 0000-0002-2717-011X AD - Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. FAU - Neilan, Anne M AU - Neilan AM AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Division of Pediatric Outcomes Research, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Davies, Mary-Ann AU - Davies MA AUID- ORCID: 0000-0001-8496-6475 AD - Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. FAU - Freedberg, Kenneth A AU - Freedberg KA AUID- ORCID: 0000-0001-6471-7930 AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Harvard University Center for AIDS Research, Boston, Massachusetts, USA. AD - Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA. FAU - Fassinou, Patricia AU - Fassinou P AD - Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Cote d'Ivoire. FAU - Doherty, Meg AU - Doherty M AD - Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland. FAU - Essajee, Shaffiq AU - Essajee S AD - UNICEF, New York, USA. FAU - Mushavi, Angela AU - Mushavi A AD - Ministry of Health and Child Care, Harare, Zimbabwe. FAU - Soeteman, Djora I AU - Soeteman DI AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. FAU - Ciaranello, Andrea L AU - Ciaranello AL AD - Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA. AD - Harvard University Center for AIDS Research, Boston, Massachusetts, USA. LA - eng GR - K08 HD101342/HD/NICHD NIH HHS/United States GR - U01AI069924/NH/NIH HHS/United States GR - R01 HD079214/HD/NICHD NIH HHS/United States GR - K08HD101342/NH/NIH HHS/United States GR - 001/WHO_/World Health Organization/International GR - R01HD079214/NH/NIH HHS/United States GR - K08HD094638/NH/NIH HHS/United States GR - K08 HD094638/HD/NICHD NIH HHS/United States GR - U01 AI069924/AI/NIAID NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - Switzerland TA - J Int AIDS Soc JT - Journal of the International AIDS Society JID - 101478566 SB - IM MH - Infant MH - Pregnancy MH - Child MH - Humans MH - Female MH - Adolescent MH - Child, Preschool MH - *HIV Infections/diagnosis/epidemiology/prevention & control MH - HIV MH - Cote d'Ivoire/epidemiology MH - South Africa/epidemiology MH - Prevalence MH - Zimbabwe/epidemiology MH - HIV Testing PMC - PMC9753158 OTO - NOTNLM OT - Africa < region OT - HIV care continuum OT - modelling OT - paediatrics OT - testing OT - vertical transmission COIS- The authors have no competing interests to disclose. EDAT- 2022/12/16 06:00 MHDA- 2022/12/17 06:00 PMCR- 2022/12/15 CRDT- 2022/12/15 07:13 PHST- 2022/02/28 00:00 [received] PHST- 2022/11/22 00:00 [accepted] PHST- 2022/12/15 07:13 [entrez] PHST- 2022/12/16 06:00 [pubmed] PHST- 2022/12/17 06:00 [medline] PHST- 2022/12/15 00:00 [pmc-release] AID - JIA226045 [pii] AID - 10.1002/jia2.26045 [doi] PST - ppublish SO - J Int AIDS Soc. 2022 Dec;25(12):e26045. doi: 10.1002/jia2.26045.