A.31.HIV point prevalence in malnourished children admitted to Nutritional Rehabilitation Units (NRUs) in Malawi: geographical variations & acceptance of testing
Thurstans SA, Kerac M, Maleta K, Banda T, Nesbitt A.
HIV and malnutrition are inextricably linked. Malnutrition associated with HIV in childhood presents a serious humanitarian and public health challenge in Southern Africa. Yet, HIV care and the treatment of severe malnutrition have remained largely separate. The aim of this study was to collect data which would inform and improve service delivery in Malawi. Knowing baselines and variations in HIV prevalence amongst malnourished children is important for successfully implementing ARV roll-out strategies.
For this cross sectional study, 4 representative NRUs were selected in the 3 regions of Malawi, both urban and rural. All children and their caretakers admitted in the NRU over a two week period during the dry season were offered VCT. HIV testing was done using two different rapid antibody tests, with PCR testing for discordant results. Children under 15 months were excluded, avoiding difficulties with false positive rapid test results.
145 of 158 children were eligible to take part. 99% of caretakers gave informed consent to take part in HIV testing, and all participants wanted test results. 52% of mothers consented to themselves being tested. HIV prevalence overall was 30.01%(C.I. 22-37). This was highest in the South 42%(C.I. 30-54), lowest in the Central region, 16% (C.I. 6, 26). Urban and rural prevalence was 50%(C.I. 36-64) and 19%(C.I. 11-27) respectively.
HIV is a significant problem amongst children in Malawian NRUs. We found that testing is widely acceptable. With marked regional and rural-urban variations in prevalence, resources should initially be targeted to areas of highest need. The results indicate the need for integration of HIV services and nutrition rehabilitation units in order to provide holistic, effective care to malnourished children and their families