Modified Integrated Algorithm for Detection of HIV Among Sick Children Aged 0–14 Year Seeking Care at Healthcare Facilities in India

Objective To test the ability and to identify unique criteria in a Modified Integrated Algorithm developed by Indian Council of Medical Research (ICMR) to detect HIV infection among sick children 0 to 14 years, seeking care in a health care facility. Design Facility based cross-sectional survey. Setting Four talukas of Belgaum District, Karnataka, India during 2013–2014. Patients Sick children 0–14 years seeking care at healthcare facilities in the study area. Procedure A total of 10 health care facilities were selected using specific criteria. Trained health care providers in these facilities used the WHO generic Integrated Management of Childhood Illnesses screening algorithm for HIV, applicable for children to 0–5 years and ICMR modified integrated algorithm for >5–14 years, to screen and test children for HIV, when they sought care in these facilities. Main Outcome measure Prevalence of HIV in children screened positive by the Modified Integrated Algorithm. Results Of the total 33342 children who visited the 10 health care facilities, 24342 were screened by the physician. Of the 527 screened positive sick children with suspected signs/symptoms, 509 consented and were tested with age appropriate HIV testing. 97 children tested positive (HIV prevalence 19.1%: 5% in <5yrs and 28% in ≥5–14 years). The result of Classification and Regression Tree and logistics regression consistently identified parents with HIV and orphan child, as important predictor of HIV infection. Conclusion ICMR Modified integrated algorithm may be used as a screening tool in the public and private health care facilities to increase case detection of pediatric HIV.