Infectious disease screening outcomes and reducing barriers to care for unaccompanied asylum-seeking children: a single-centre retrospective clinical analysis.

OBJECTIVE: Evaluate the Unity Clinic's infectious disease screening programme for unaccompanied asylum-seeking children (UASC), calculate rates of infection and identify further health needs. DESIGN: Retrospective audit of electronic patient data. SETTING AND PATIENTS: UASC who attended the Unity Clinic between 1 November 2019 and 22 March 2022. MAIN OUTCOME MEASURES: Baseline demographics, social, mental health and journey details, infection screening and investigation results. RESULTS: 155 UASC were reviewed: 89% (138 of 155) male, median age 17 years (IQR 16-17). Most frequent countries of origin were Sudan, Eritrea and Afghanistan. Median duration of travel to the UK (n=79) was 2 years (IQR 0.5-4); 35.6% (47 of 132) arrived by boat and 54.5% (72 of 132) by road. 44.8% (69 of 154) had one or more positive infection screening results: 22.7% (35 of 154) and 1.3% (2 of 154) positive for latent and active tuberculosis, respectively; 4.6% (7 of 152) chronic active hepatitis B and 17.1% (26 of 152) for past infection; 1.3% (2 of 154) for HIV; 13.0% (19 of 146) for Strongyloides. There were three cases of syphilis (n=152; 2.0%) and one chlamydia (n=148; 0.7%)-none of whom disclosed prior sexual activity during screening. 39.6% (61 of 154) and 27.9% (43/154) reported disturbances to mood or sleep, respectively. 55.2% (85 of 154) disclosed traumatic incidents during and/or prior to their journey, including physical and sexual assault. CONCLUSIONS: The Unity Clinic provides a thorough infectious disease screening service for UASC following national guidance. Results highlight the need for universal, non-judgemental screening for sexually transmitted infections, as targeted screening would not identify positive cases. High rates of well-being issues and previous abuse emphasise the need for multidisciplinary, collaborative approaches to care.

Over a third of childbearing women with HIV would like to breastfeed: A UK survey of women living with HIV.

The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.