Active case finding: comparison of the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated-testing and counseling of HIV among children and adolescents in Cameroon

Abstract

BackgroundChildren and adolescents still lag behind adults in accessing antiretroviral therapy (ART), which is largely due to their limited access to HIV testing services. This study compares the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated testing and counseling (PITC) among children and adolescents in Cameroon.MethodsDuring a 6-month period in three hospitals in Cameroon, we invited HIV-positive parents to have their biological children (6 weeks-19 years) tested for HIV (targeted PITC). During that same period and in the same hospitals, we also systematically offered HIV testing to all children evaluated at the outpatient department (blanket PITC). Children of consenting parents were tested for HIV, and positive cases were enrolled on ART. We compared the acceptability, feasibility and effectiveness of targeted and blanket PITC using Chi-square test at 5% significant level.ResultsWe enrolled 1240 and 2459 eligible parents in the targeted PITC (tPITC) and blanket PITC (bPITC) group, and 99.7% and 98.8% of these parents accepted the offer to have their children tested for HIV, respectively. Out of the 1990 and 2729 children enrolled in the tPITC and bPITC group, 56.7% and 90.3% were tested for HIV (p < 0.0001), respectively. The HIV positivity rate was 3.5% (CI:2.4–4.5) and 1.6% (CI:1.1–2.1) in the tPITC and bPITC (p = 0.0008), respectively. This finding suggests that the case detection was two times higher in tPITC compared to bPITC, or alternatively, 29 and 63 children have to be tested to identify one HIV case with the implementation of tPITC and bPITC, respectively. The majority (84.8%) of HIV-positive children in the tPITC group were diagnosed earlier at WHO stage 1, and cases were mostly diagnosed at WHO stage 3 (39.1%) (p < 0.0001) in the bPITC group. Among the children who tested HIV-positive, 85.0% and 52.5% from the tPITC and bPITC group respectively, were enrolled on ART (p = 0.0018).ConclusionsThe tPITC and bPITC strategies demonstrated notable high HIV testing acceptance. tPITC was superior to bPITC in terms of case detection, case detection earliness and linkage to care. These findings indicate that tPITC is effective in case detection and linkage of children and adolescents to ART.Trial registrationTrial registration Number: NCT03024762. Name of Registry: ClinicalTrial.gov. Date registration: January 19, 2017 (‘retrospectively registered’). Date of enrolment first patient: 15/07/2015.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1276-7) contains supplementary material, which is available to authorized users.

Parental and child-level predictors of HIV testing uptake, seropositivity and treatment initiation among children and adolescents in Cameroon

“…This article is drawn from a sub-analysis of the dataset for "Active Search for Pediatric HIV/ AIDS" (ASPA), a cross-sectional study assessing the acceptability, feasibility and effectiveness of tPITC versus bPITC in Cameroon [9]. The ASPA study was implemented at three government hospitals: Limbe Regional Hospital (LRH) in the South-West, Ndop District Hospital (NDH) in the North-West and Abong-Mbang District Hospital (ADH) in the Eastern Region.…”

“…Already described in the early 2000s [7], index case testing among children is grounded in the knowledge that > 90% of pediatric HIV infections result from vertical transmission of HIV [8]. Thus, targeting for HIV testing children of parents known to be living with HIV (index cases) is a potentially high-yield case finding and linkage approach, especially when compared to universal provider-initiated testing and counselling [9]. Index case testing for children was first recommended by UNICEF and WHO in 2010 [10] with variable levels of implementation across countries [11].…”

“…Index case testing for children was first recommended by UNICEF and WHO in 2010 [10] with variable levels of implementation across countries [11]. Recent operational research from Kenya, Malawi and Cameroon have shown that index case testing is acceptable, feasible and effective in HIV case-identification and timely ART enrollment for children and adolescents [9,[12][13][14]. In a previous publication, we named this strategy, "targeted provider initiated testing and counselling (tPITC)" as opposed to the universal or blanket PITC (bPITC) [9].…”

“…Recent operational research from Kenya, Malawi and Cameroon have shown that index case testing is acceptable, feasible and effective in HIV case-identification and timely ART enrollment for children and adolescents [9,[12][13][14]. In a previous publication, we named this strategy, "targeted provider initiated testing and counselling (tPITC)" as opposed to the universal or blanket PITC (bPITC) [9]. In that article, we demonstrated the superiority of tPITC over the bPITC in terms of case detection and ART enrollment among Cameroonian children and adolescents.…”

“…In that article, we demonstrated the superiority of tPITC over the bPITC in terms of case detection and ART enrollment among Cameroonian children and adolescents. We reported that although tPITC acceptability among parents was extremely high at 99.7%, HIV testing uptake was moderate at 56.7% and ART linkage was 85% [9]. In Kenya, Wagner et al found that among 48% of in-care parents living with HIV who consented to testing their eligible children for HIV, only 14% ultimately tested one or more children [12].…”