Coverage and predictors of pediatric index case testing among children of HIV infected parents
DOI:
https://doi.org/10.20372/ejphn.v7i1.249Keywords:
Pediatric HIV, Index case testing, MTCT knowledgeAbstract
Background: Antiretroviral therapy coverage in adults with HIV has reached 60%-90% in many Sub-Saharan African countries but remains low (48%) for children <15 years living with HIV. One possible reason for this low pediatric antiretroviral therapy performance is low pediatric HIV case finding. Testing of children of HIV infected parents also called index case testing is the primary HIV case finding approach for the pediatric age group. In this study we describe the coverage of index case testing for children of infected parents and factors affecting it.
Methods: The Zambia, Malawi, Eswatini, and Tanzania Population HIV Impact Assessment household surveys were conducted between 2015 and 2016. Rapid HIV testing was conducted for consenting adults. Couples where there is at least one HIV infected person were identified and matched to their children <15 years. HIV testing status of children was measured and factors associated with testing of children studied using logistic regression. Sampling weights were applied during analysis taking into account complex sampling design of these surveys.
Results: Of 13,212 couples included in population HIV Impact Assessment survey, 1,570 had at least one HIV infected partner, and hence all their children were eligible for HIV testing. The average number of children <15 years per couple with at least one HIV infected partner was 2.23 (2.17-2.29) making the total number of children <15 years 3,435. Of those children, 38.9% (32.9%-44.8%) were tested for HIV. There is more testing among children <5 years compared to 5-14 year old (47.8% vs 31.8%, p value <0.001). Rural areas have more undiagnosed children in all study countries. Maternal HIV testing was associated with the highest odds of testing for children (adjusted Odds ratio: 84.51 (10.72- 666)) as was maternal HIV infection (Odds ratio: 5.9 (95% confidence interval (CI): 3.9-8.9)) while paternal testing and HIV infection were not associated with HIV testing for children.
Conclusion: Pediatric HIV testing for children of HIV infected parent(s) was found to be low. Maternal HIV testing was found to be the single most important factor to get a child tested for HIV among couples where there was at least one index HIV parent. Rural settings need to be prioritized for index case testing in order to address testing gap.
Downloads
References
Ahmed S, Kim MH, Sugandhi N, Phelps BR, Sabelli R, Diallo MO, et al. (2013). Beyond early infant diagnosis: case finding strategies for identification of HIV-infected infants and children. AIDS, 27(02): S235.
Bandason T, Langhaug LF, Makamba M, Laver S, Hatzold K, Mahere S, et al. (2013). Burden of HIV among primary school children and feasibility of primary school-linked HIV testing in Harare, Zimbabwe: a mixed methods study. AIDS care, 25(12): 1520-1526.
Cohen D, Lungu M & Van Oosterhout J (2010). HIV testing coverage of family members of adult antiretroviral therapy patients in Malawi. AIDS care, 22(11): 1346-1349.
Croft TN, Marshall AM, Allen CK, Arnold F, Assaf S & Balian S (2018). Guide to DHS statistics. Rockville: ICF.
Federal Ministry of Health (2013). Reference Manual for PMTCT Option B+ Update Training.
Ferrand RA, Luethy R, Bwakura F, Mujuru H, Miller RF & Corbett EL (2007). HIV infection presenting in older children and adolescents: a case series from Harare, Zimbabwe. Clinical infectious diseases, 44(6): 874-878.
Gesesew HA, Ward P, Woldemichael K, Lyon P & Mwanri L (2020). Policy and practice suggestions to improve performance on the UNAIDS 90‐90‐90 targets: Results from a nominal group technique with HIV experts in Southwest Ethiopia. Health Expectations.
Goggin K, Hurley EA, Staggs VS, Wexler C, Nazir N, Gautney B, et al. (2019). Rates and predictors of hiv-exposed infants lost to follow-up during early infant diagnosis services in Kenya. AIDS patient care and STDs, 33(8): 346-353.
Kankasa C, Carter RJ, Briggs N, Bulterys M, Chama E, Cooper ER, et al. (2009). Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility. Journal of acquired immune deficiency syndromes, 51(2): 202.
Kelley AL, Karita E, Sullivan PS, Katangulia F, Chomba E, Carael M, et al. (2011). Knowledge and perceptions of couples' voluntary counseling and testing in urban Rwanda and Zambia: a cross- sectional household survey. PloS one, 6(5): e19573. Lewis Kulzer J, Penne JA, Marima R, Oyaro P, Oyanga AO, Shade SB, et al. (2012). Family model of HIV care and treatment: a retrospective study in Kenya.
Journal of the International AIDS Society, 15(1): 8- 8.
Marston M, Becquet R, Zaba B, Moulton LH, Gray G, Coovadia H, et al. (2011). Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa. International journal of epidemiology, 40(2): 385-396.
Marwa R & Anaeli A (2020). Perceived barriers toward Provider-Initiated HIV Testing and Counseling (PITC) in pediatric clinics: A qualitative study involving two regional hospitals in Dar-Es-Salaam, Tanzania. HIV/AIDS (Auckland, NZ), 12: 141.
McCollum ED, Preidis GA, Kabue MM, Singogo EB, Mwansambo C, Kazembe PN, et al. (2010). Task shifting routine inpatient pediatric HIV testing improves program outcomes in urban Malawi: a retrospective observational study. PloS one, 5(3): e9626.
Ministry of Health (2017). National Comprehensive HIV Prevention, Care and Treatment Training for Health care Providers.
Musarandega R, Mutede B, Mahomva A, Nyamayaro W, Mushavi A, Lindan C, et al. (2018). Scaling up pediatric HIV testing by incorporating provider- initiated HIV testing into all child health services in Hurungwe District, Zimbabwe. Journal of acquired immune deficiency syndromes (1999), 77(1): 78.
Newell M, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P & Dabis F (2004). Ghent International AIDS Society (IAS) Working Group on HIV infection in women and children. Mortality of infected and uninfected infants born to HIV- infected mothers in Africa: a pooled analysis. Lancet, 364(9441): 1236-1243.
PEPFAR (2019). Annual report to congress. Population-based HIV Impact Assessment (PHIA) data use manual 2019 (2019). New York.
Saito S, Chung H, Mahy M, Radin AK, Jonnalagadda S, Hakim A, et al. (2018). Pediatric HIV treatment gaps in 7 East and Southern African Countries: examination of modeled, survey, and routine program data. Journal of Acquired Immune Deficiency Syndromes (1999), 78: S134-S141.
Simon KR, Flick RJ, Kim MH, Sabelli RA, Tembo T, Phelps BR, et al. (2018). Family testing: an index case finding strategy to close the gaps in pediatric HIV diagnosis. Journal of acquired immune deficiency syndromes (1999), 78(Suppl 2): S88.
Strauss M, Rhodes B & George G (2015). A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa. BMC health services research, 15(1): 250.
Tanzania Commission for AIDS (TACAIDS) (2018). Tanzania HIV Impact Survey (THIS) 2016-2017: Final Report. Dar es Salaam, Tanzania.
UNAIDS (2019). Data (Accessed from https://www.unaids.org/en/resources/documents/20 19/2019-UNAIDS-data).
UNICEF, UNDP, UNFPA, ILO, WHO & World Bank
(2011). Opportunity in crisis: preventing HIV from early adolescence to early adulthood. New York: UNICEF.
USAID (2020). Maximizing coverage of index testing for biological children of mothers living with HIV: Standard Operating Procedure (SOP) (from: http://ovcsupport.org/wp- content/uploads/2020/07/OVC-Index-Testing-SOP-07.17.20.pdf).
Wagner AD, Mugo C, Njuguna IN, Maleche-Obimbo E, Sherr K, Inwani IW, et al. (2016). Implementation and operational research: active referral of children of HIV-positive adults reveals high prevalence of undiagnosed HIV. Journal of Acquired Immune Deficiency Syndromes, 73(5): e83-e89.
Wagner AD, O’malley G, Firdawsi O, Mugo C, Njuguna IN, Maleche-Obimbo E, et al. (2018). Disclosure, consent, opportunity costs, and inaccurate risk assessment deter pediatric HIV testing: a mixed-methods study. Journal of acquired immune deficiency syndromes (1999), 77(4): 393.
Wall KM, Kilembe W, Nizam A, Vwalika C, Kautzman M, Chomba E, et al. (2012). Promotion of couples’ voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents. BMJ open, 2(5): 1-10.
Woldesenbet SA, Jackson D, Goga AE, Crowley S, Doherty T, Mogashoa MM, et al. (2015). Missed opportunities for early infant HIV diagnosis: results of a national study in South Africa. Journal of acquired immune deficiency syndromes (1999), 68(3): e26.
World Health Organisation (2015). WHO Guidelines on HIV Testing.
World Health Organisation (2016). Guideline on HIV self testing and partner notification.
Yeap A, Hamilton R, Charalambous S, Dwadwa T, Churchyard G, Geissler P, et al. A (2010). Factors influencing uptake of HIV care and treatment among children in South Africa–a qualitative study of caregivers and clinic staff. AIDS care, 22(9): 1101-1107.
Zambian Ministry of Health. (2019). Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2016: Final Report. Lusaka.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Ethiopian Journal of Public Health and Nutrition (EJPHN)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This work is licensed under GNU General public license.