Abstract:
The study aimed to evaluate IMCI guidelines, developed to assess children with Suspected
Symptomatic HIV [SSHIV] as a screening tool for AIDS.
OBJECTIVES
1. To look at the agreement between IMCI classification for SSHIV and WHO clinical case
definition for AIDS using a retrospective record review of the same hospitalised children.
2. To determine the sensitivity, specificity, positive predictive values and likelihood ratios of
the IMCI SSHIV criteria (Guidelines 2001), WHO clinical case definition for paediatric
AIDS and Bloemfontein Proposed simplified case definition for paediatric SSHIV, using
HIV ELISA results in children older than 15 months as a gold standard.
METHODS
The study involved 304 children in the IMCI age range who were admitted to the Edenvale
Hospital during the study period and who met all the inclusion and exclusion criteria. These
children were assessed with IMCI criteria and WHO criteria for AIDS. [Objective 1]
The findings of 50 children above 15 months of age with ELISA results were compared using
3 sets of criteria. [IMCI, WHO and Bloemfontein proposed simplified case definition for
paediatric SSHIV] [Objective 2]
FINDINGS
IMCI and WHO criteria for AIDS were the same in 158 [52%] of the 304 children. Almost all
[22 out of 23 children] with WHO criteria for AIDS were also classified by IMCI criteria as
Suspected Symptomatic HIV. [Objective 1]
v
IMCI criteria had the highest sensitivity [85.7%], while WHO criteria had the highest
specificity [88%] based on ELISA results. [Objective 2]
CONCLUSION
Based on the above findings, IMCI criteria could be considered as a screening tool to select
children aged 15 months and above for appropriate laboratory investigation for HIV infection
confirmation in remote areas. WHO criteria for AIDS could be considered for exclusion of
AIDS in children aged 15 months and above in remote areas where laboratory facilities are not
available.
In this study, reliable findings could not be obtained in children younger than 15 months.
