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HIV counselling and testing practices for children seen in an urban emergency department of a tertiary referral hospital in Dar es Salaam, Tanzania: a retrospective cross-sectional study
  1. Hendry R Sawe1,2,
  2. Juma A Mfinanga1,2,
  3. Faith H Ringo2,
  4. Victor Mwafongo1,2,
  5. Teri A Reynolds1,3,
  6. Michael S Runyon1,4
  1. 1Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  2. 2Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
  3. 3Department of Emergency Medicine and Global Health Sciences, University of California, San Francisco, California, USA
  4. 4Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
  1. Correspondence to Dr Michael S Runyon; michael.runyon{at}carolinas.org

Abstract

Objectives To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country.

Setting The ED of a large east African national referral hospital.

Participants This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male.

Primary and secondary outcome measures The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive.

Results Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge.

Conclusions Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care.

  • HIV testing
  • HIV counseling
  • Emergency medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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