Performance Of The Integrated Management Of Childhood Illness Algorithm For Diagnosis Of Hiv-1 Infection Among African Infants.
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Date
2012Author
Diener
Slyker, Jennifer
Christinei, Gichuh
Dalton, Wamalwa
Lara, C.
Tapia, Kenneth A
Richardson, Barbra A.
Dalton, Wamalwa
Farquhar, Carey
Overbaugh, Julie Maleche-Obimbo Elizabeth
Maleche-Obimbo, Elizabeth
John-Stewart, Grace
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http://profiles.uonbi.ac.ke/cgichuhi/publications/performance-integrated-management-childhood-illness-algorithm diagnosis-hiv-1
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ArticleLanguage
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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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http://profiles.uonbi.ac.ke/cgichuhi/publications/performance-integrated-management-childhood-illness-algorithm-diagnosis-hiv-1http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/30157
http://journals.lww.com/aidsonline/Fulltext/2012/09240/Performance_of_the_integrated_management_of.10.aspx
http://www.ncbi.nlm.nih.gov/pubmed/22824627
Citation
Performance of the integrated management of childhood illness algorithm for diagnosis of HIV-1 infection among African infants., Diener, Lara C., Slyker Jennifer A., Christine Gichuhi, Dalton Wamalwa, Tapia Kenneth A., Richardson Barbra A., Dalton Wamalwa, Farquhar Carey, Overbaugh Julie, Maleche-Obimbo Elizabeth, and John-Stewart Grace , AIDS (London, England), 2012 Sep 24, Volume 26, Issue 15, p.1935-41, (2012)Publisher
University of Nairobi School of medicine (Paediatrics)
Collections
- Faculty of Health Sciences (FHS) [10377]