HIV in children in a general population sample in East Zimbabwe: prevalence, causes and effects.

BACKGROUND: There are an estimated half-million children living with HIV in sub-Saharan Africa. The predominant source of infection is presumed to be perinatal mother-to-child transmission but general population data about paediatric HIV are sparse. We characterise the epidemiology of HIV in children in sub-Saharan Africa by describing the prevalence possible source of infection and effects of paediatric HIV in a southern African population. METHODS: From 2009 to 2011 we conducted a household-based survey of 3389 children (aged 2-14 years) in Manicaland eastern Zimbabwe (response rate: 73.5%). Data about socio-demographic correlates of HIV risk factors for infection and effects on child health were analysed using multi-variable logistic regression. To assess the plausibility of mother-to-child transmission child HIV infection was linked to maternal survival and HIV status using data from a 12-year adult HIV cohort. RESULTS: HIV prevalence was (2.2% 95% CI: 1.6-2.8%) and did not differ significantly by sex socio-economic status location religion or child age. Infected children were more likely to be underweight (19.6% versus 10.0% p = 0.03) or stunted (39.1% versus 30.6% p = 0.04) but did not report poorer physical or psychological ill-health. Where maternal data were available reported mothers of 61/62 HIV-positive children were deceased or HIV-positive. Risk factors for other sources of infection were not associated with child HIV infection including blood transfusion vaccinations caring for a sick relative and sexual abuse. The observed flat age-pattern of HIV prevalence was consistent with UNAIDS estimates which assumes perinatal mother-to-child transmission although modelled prevalence was higher than observed prevalence. Only 19/73 HIV-positive children (26.0%) were diagnosed but of these 17 were on antiretroviral therapy. CONCLUSIONS: Childhood HIV infection likely arises predominantly from mother-to-child transmission and is associated with poorer physical development. Overall antiretroviral therapy uptake was low with the primary barrier to treatment appearing to be lack of diagnosis.