HIV prevention and undiagnosed infections in children in sub-Saharan Africa

Despite the efforts to prevent vertical transmission of HIV, about 130 000 children worldwide acquire HIV each year, and 40% of those remain undiagnosed. Many factors contribute to this poor outcome including, but not limited to, failure to identify mothers seroconverting during pregnancy or postpartum, suboptimal early infant diagnosis, misinterpretation of negative test results in children before the end of breastfeeding, and child testing not being a key indicator for national programmes. To close the paediatric HIV diagnosis gap and improve child mortality rates, several changes are necessary. These changes include intensifying HIV retesting efforts to identify women who seroconvert during pregnancy or breastfeeding, counselling caregivers and health-care providers on the necessity of doing a final HIV test in children after breastfeeding ends, setting a formal indicator for child testing between age 18 months and 24 months, and extending child HIV diagnosis as a concern for all health-care workers when the children leave the programme to prevent vertical transmission of HIV after 2 years.