Diagnosis of paediatric HIV infection presents a spectrum of challenges particularly in countries where resources are constrained. This program of research aims to illuminate epidemiological and clinical aspects of HIV diagnosis in resource limited settings focusing in particular on the nation of Papua New Guinea (PNG). This body of work commences with an exploration of current literature pertaining to diagnosis of HIV infection in resource constrained settings. This exploration encompasses the current epidemiological data available on HIV infection in the paediatric population worldwide, currently available methods of diagnosis and other aspects of diagnosis of paediatric HIV infection in developing nations including sampling considerations, breast feeding, health services, human resources and the relationship between early diagnosis and early treatment. The next chapter presents an epidemiological analysis of the HIV epidemic in PNG and a description of the paediatric services at Port Moresby General Hospital (PMGH) the site for most of the research presented in the thesis. The original research presented in the thesis begins with a report (Chapter 3) of a survey of paediatric diagnosis and treatment services in PNG in comparison to other countries in the Asia Pacific region. This is followed by an exploratory retrospective study elucidating factors associated with HIV testing and HIV positive serostatus in children admitted to PMGH. Selection for testing was found to be significantly associated with age, length of hospital stay and diagnoses of diarrhoea, malnutrition and oral candidiasis. Tuberculosis was associated with HIV positive serostatus. In advance of a prospective study to ascertain clinical predictors of HIV infection, a study to evaluate acceptability of HIV testing amongst carers of children admitted to PMGH was undertaken. Testing was acceptable to the majority of carers interviewed. This program of research concludes with a prospective cross-sectional study revealing low weight for age, persistent fever, lymphadenopathy and oral candidiasis to be independent predictors of HIV infection in children admitted to PMGH. An algorithm for clinically directed screening of children for HIV infection in a hospital setting was subsequently developed. Finally evidence based clinical recommendations and suggestions for the direction of future research efforts were made.
| Identifer | oai:union.ndltd.org:ADTP/272567 |
| Date | January 2009 |
| Creators | Allison, Waridibo Evelyn, National Centre in HIV Epidemiology & Clinical Research, Faculty of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. National Centre in HIV Epidemiology & Clinical Research |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Allison Waridibo Evelyn., http://unsworks.unsw.edu.au/copyright |
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