TY - JOUR
T1 - Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan
T2 - Protocol for a matched case - Control study
AU - Siddiqui, Amna R.
AU - Ali Nathwani, Apsara
AU - Abidi, Syed H.
AU - Mahmood, Syed Faisal
AU - Azam, Iqbal
AU - Sawani, Sobiya
AU - Kazi, Abdul M.
AU - Hotwani, Aneeta
AU - Memon, Sikander Ali
AU - Soomro, Jamila
AU - Shaikh, Saqib Ali
AU - Achakzai, Baseer
AU - Saeed, Quaid
AU - Simms, Victoria
AU - Khan, Palwasha
AU - Ferrand, Rashida
AU - Mir, Fatima
N1 - Funding Information:
This study is funded by the Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. RAF is funded by the Wellcome Trust through a Senior Fellowship in Clinical Science (206316/Z/17/Z)
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/3/25
Y1 - 2020/3/25
N2 - Introduction In April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ever outbreak of HIV in children in Pakistan. In this protocol paper, we describe research methods for assessing likely modes of HIV transmission in this outbreak and investigate spatial and molecular epidemiology. Methods and analysis A matched case-control study will be conducted with 406 cases recruited. Cases will be children aged below 16 years registered for care at the HIV treatment centre at Shaikh Zayed Children Hospital in Larkana City. Controls will be children who are HIV-uninfected (confirmed by a rapid HIV test) matched 1:1 by age (within 1 year), sex and neighbourhood. Following written informed consent from the guardian, a structured questionnaire will be administered to collect data on sociodemographic indices and exposure to risk factors for parenteral, vertical and sexual (only among those aged above 10 years) HIV transmission. A blood sample will be collected for hepatitis B and C serology (cases and controls) and HIV lineage studies (cases only). Mothers of participants will be tested for HIV to investigate the possibility of mother-to-child transmission. Conditional logistic regression will be used to investigate the association of a priori defined risk factors with HIV infection. Phylogenetic analyses will be conducted. Global positioning system coordinates of participants' addresses will be collected to investigate concordance between the genetic and spatial epidemiology. Ethics and dissemination Ethical approval was granted by the Ethics Review Committee of the Aga Khan University, Karachi. Study results will be shared with Sindh and National AIDS Control Programs, relevant governmental and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals.
AB - Introduction In April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ever outbreak of HIV in children in Pakistan. In this protocol paper, we describe research methods for assessing likely modes of HIV transmission in this outbreak and investigate spatial and molecular epidemiology. Methods and analysis A matched case-control study will be conducted with 406 cases recruited. Cases will be children aged below 16 years registered for care at the HIV treatment centre at Shaikh Zayed Children Hospital in Larkana City. Controls will be children who are HIV-uninfected (confirmed by a rapid HIV test) matched 1:1 by age (within 1 year), sex and neighbourhood. Following written informed consent from the guardian, a structured questionnaire will be administered to collect data on sociodemographic indices and exposure to risk factors for parenteral, vertical and sexual (only among those aged above 10 years) HIV transmission. A blood sample will be collected for hepatitis B and C serology (cases and controls) and HIV lineage studies (cases only). Mothers of participants will be tested for HIV to investigate the possibility of mother-to-child transmission. Conditional logistic regression will be used to investigate the association of a priori defined risk factors with HIV infection. Phylogenetic analyses will be conducted. Global positioning system coordinates of participants' addresses will be collected to investigate concordance between the genetic and spatial epidemiology. Ethics and dissemination Ethical approval was granted by the Ethics Review Committee of the Aga Khan University, Karachi. Study results will be shared with Sindh and National AIDS Control Programs, relevant governmental and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals.
KW - HIV
KW - Pakistan
KW - case-control study
KW - children
KW - outbreak
UR - http://www.scopus.com/inward/record.url?scp=85082469193&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2019-036723
DO - 10.1136/bmjopen-2019-036723
M3 - Article
C2 - 32213527
AN - SCOPUS:85082469193
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e036723
ER -
