Bedside paediatric HIV testing in Malawi: Impact on testing rates

Aims: Provider initiated testing and counselling (PITC) is recommended for all inpatients in Malawi if they have not been tested in the previous 3 months. However testing rates remain low among children. We audited the effect of implementing a bedside diagnostic HIV testing service to determine if it would improve testing rates amongst paediatric inpatients.

Methods: We audited the existing HIV testing service to determine the numbers of children being tested for HIV. This was followed by the introduction of a bedside diagnostic service followed by re-audit. Bedside testing was facilitated by health systems strengthening measures including identification of suitable counselors,appropriate supervision and remuneration.

Results: In the initial audit in March-April 2014, 85 (63%) of 135 children haddocumented HIVtests, with 50 (37%) having no documented test. Following implementation of the bedside HIV testing service, there was a significant increase in the proportion of children whose HIV status was known. On re-audit in July 2015,110 (94.8%) of 116 children had documented HIV tests, with 6 (5.2%) having no documented test. [‘known HIV status’ of inpatients X2(1,N=251) = 36.55, p<0.001].Of those with documented tests, 94.5% had been tested within the last 3-months compared to 61% in 2014. Following the introduction of the service, the proportion of children tested for HIV during admission increased from 31.9% to 68.1%[X2(1,N=251) = 32.82, p<0.001].

Conclusion: A bedside diagnostic HIV testing service lead to increased HIV testing rates among paediatric inpatients compared to a non-bedside service.