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. 2014 Jun;6(2):82-92.
doi: 10.1093/inthealth/ihu024. Epub 2014 May 19.

Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice

Henrieke A B Prins  1 , Peter Mugo  2 , Elizabeth Wahome  2 , Grace Mwashigadi  2 , Alexander Thiong'o  2 , Adrian Smith  3 , Eduard J Sanders  4 , Susan M Graham  5
Affiliations

Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice

Henrieke A B Prins et al. Int Health. 2014 Jun.

Abstract

Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003-2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18-29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis.

Keywords: Acute disease; Adults; Fever; HIV-1; Outpatients; Sub-Saharan Africa.

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Figures

Figure 1.
Figure 1.
Results of the search and screening process. Template adapted from PRISMA 2009 flow diagram. SSA: sub-Sahara Africa.
Figure 2.
Figure 2.
Health facilities included in the audit of current practice. Numbers on the map correspond to numbers as listed in 2.
See this image and copyright information in PMC

Comment in

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