The worst thing I saw today

In the HIV section of a case report form “mom refused testing.” The child was one year old.

Most of the CRFs don’t have any extraneous writing, it is just boxes checked or lines filled in. Still, a lot is apparent about HIV testing in South Africa. People definitely are not testing when they should be. Stigma and denial must be huge factors, as well as worrying about having access to treatment if diagnosed.

I am only seeing cases with invasive pneumococcal disease, which is itself a warning sign about HIV status. Sometimes, a patient will have wasting and candidiasis or TB and candidiasis and the box is checked that they refused testing. Sometimes there is a CD4 count, which indicates the doc thought there was HIV and is going to try to treat the patient without acknowledging that they have HIV.

Sometimes I see a narrative through CRFs. Someone has the box checked for suspected HIV and they have AIDS defining illnesses but they refused testing. Then, three months later, there is another set of CRFs and they are positive.

Jeff