741 - HIV Testing Practices in a Cohort of Previously Healthy Pediatric Injury Patients in Northern Tanzania

Publication Number: 741.5237

Kajsa Vlasic, University of Utah School of Medicine, Salt Lake City, UT, United States; Francis M. Sakita, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania; Abigail McRea, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Bryan Young, University of Utah, Salt Lake City, UT, United States; Catherine Staton, Duke University School of Medicine, Durham, NC, United States; Dorothy Dow, Duke University, Durham, NC, United States; Getrude M. Nkini, KCMC-Duke Collaboration, Moshi mjini, Kilimanjaro, Tanzania; Irene Richard. Mushi, KCMC DUKE COLLABORATION, Moshi, Kilimanjaro, Tanzania; Melissa H.. Watt, University of Utah, School of Medicine, Population Health Sciences, Salt Lake City, UT, United States; Pollyana Coelho Pessoa Santos, University of North Carolina at Chapel Hill, Durham, NC, United States; Sharla Rent, Duke University School of Medicine, Durham, NC, United States; Siddhesh Zadey, Duke University, Brooklyn, NY, United States; Blandina Theophil. Mmbaga, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania; Elizabeth M. Keating, University of Utah, Salt Lake City, UT, United States

Background: Cases of pediatric HIV remain undiagnosed in disproportionate numbers. In 2023, UNICEF reported that approximately 50% of children living with HIV are undiagnosed and the majority of children known to have HIV live in Sub-Saharan Africa. The World Health Organization (WHO) recently revised HIV testing guidance to be risk-stratified as opposed to universal testing in low HIV prevalence areas such as Tanzania.

Objective: To describe HIV testing in pediatric injury patients presenting to a Northern Tanzanian emergency department (ED) and understand healthcare worker attitudes and practices regarding pediatric HIV testing prior to the 2024 WHO HIV testing guideline update.

Design/Methods: This explanatory sequential mixed methods study used pediatric injury registry data from Kilimanjaro Christian Medical Centre between 2020 - 2024 and focus group discussions (FGDs) with healthcare workers during March - April 2023. The registry included patients under 18 years who presented to the ED with an injury, and data was collected about reported HIV testing history and HIV testing during admission. FGDs were conducted with 30 healthcare workers in the ED and inpatient pediatric units. We performed quantitative statistical analysis with R and used a team-based thematic coding analysis approach to identify qualitative themes.

Results: 1058 pediatric patients were enrolled from November 2020 to August 2024. The cohort was 64% male and had a mean age of 7.7 years (SD=4.9 years). On arrival, 21% (n=220) of patients reported being previously tested for HIV; six patients reported being HIV seropositive (Figure 1). 20% (n=208) received an HIV test during their admission; all were seronegative. No registry data was collected on reasoning for HIV testing. Of the forty percent (n=423) who had surgery during hospitalization, a potential HIV testing consideration, only 24% (n=102) received an HIV test. In FGDs, which occurred before the WHO guideline update, healthcare workers described risk-based screening behavior not guided by protocol (Table 1). Responses included consideration of family history, parental HIV status, lack of expected response to treatment, and need for surgery.

Conclusion(s): Our findings support the recently updated WHO recommendation for risk-stratified screening in low prevalence areas and the need for clear risk-stratification protocols. We identified an overall low HIV testing rate and no positive cases. There is a critical need to develop and implement an HIV testing algorithm in Northern Tanzania that conserves resources, yet efficiently considers children at high risk for HIV during hospital evaluation.

Figure 1: Reported HIV status of pediatric injury patients on admission to our tertiary medical center
Figure 1.pdf

Table 1. Major themes from FGDs with healthcare workers
Table 1_updated.pdf