Effectiveness of symptom-based diagnostic HIV testing versus targeted and blanket provider-initiated testing and counseling among children and adolescents in Cameroon

Yumo, Habakkuk Azinyui; Ajeh, Rogers; Beißner, Marcus; Ndenkeh, Jackson N.; Sieleunou, Isidore; Jordan, Michael R.; Sam-Agudu, Nadia A.; Kuaban, Christopher

doi:10.1371/journal.pone.0214251

Cited by 14 publications

(12 citation statements)

References 27 publications

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“…About 24% of children with unknown status identified through the family index POS were not tested for HIV. However, the percentage of children with unknown status that was not tested (24%) in our study was much lower than the 43.3% reported by Yumo et al for neighboring Cameroon [30]. A major reason for the missed opportunity was that at this POS, the method for getting these children tested was simply to ask parents to return to the clinic with the children, and parents often did not return with their children for HIV testing as scheduled.…”

Section: Plos Onecontrasting

confidence: 77%

Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities—Nigeria, 2016-2017

et al. 2020

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Background In 2017, UNAIDS estimated that 140,000 children aged 0-14 years are living with HIV in Nigeria, but only 35% have been diagnosed and are receiving antiretroviral therapy. Children are tested primarily in outpatient clinics, which show low HIV-positive rates. To demonstrate efficient facility-based HIV testing among children aged 0-14 years, we evaluated pediatric HIV-positivity rates in points of service in select health facilities in Nigeria. Methods We conducted a retrospective analysis of HIV testing and case identification among children aged 0-14 years at all points of service at nine purposively sampled hospitals (November 2016-March 2017). Points of service included family index testing, pediatric outpatient department (POPD), tuberculosis (TB) clinics, immunization clinics, and pediatric inpatient ward. Eligibility for testing at POPD was done using a screening tool while all children with unknown status were eligible for HIV test at other points of service. The main outcome was HIV positivity rates stratified by the testing point of service and by age group. Predictors of an HIV-positive result were assessed using logistic regression. All analyses were done using Stata 15 statistical software. Results Of 2,180 children seen at all facility points of service with unknown HIV status, 1,822 (83.6%) were tested for HIV, of whom 43 (2.4%) tested HIV positive. The numbers of children tested by age group were <1 years = 230 (12.6%); 1-4 years = 752 (41.3%); 5-9 years = 520 (28.5%); and 10-14 years = 320 (17.6%). The number of children tested by point of

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Section: Plos Onecontrasting

confidence: 77%

Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities—Nigeria, 2016-2017

et al. 2020

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“…We showed where the difference lies between the states using a Post-Hoc test which revealed a significant difference in HTS outcome across board (P < 0.05). This finding is consistent with two studies carried out in Cameroon that observed that targeted provider-initiated testing and counselling (PITC) is superior to blanket PITC in HIV case finding in children [8,9]. Findings are also similar to two other studies in Malawi by Simon KR, et al [10] and Saeed A, Rachael AK, et al [11] that shows that in order to improve pediatric case finding of HIV, a one-size fits all approach for HIV programming would be less effective and therefore targeted and case specific approaches need to be utilized.…”

Section: Resultssupporting

confidence: 91%

Closing the Gap in Pediatric HIV Case Finding: A Review of the PASS Strategy in Southern Nigeria

Katbi¹,

Magaji²,

Tessie³

et al. 2020

Int J Virol AIDS

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Background: Achieving optimal treatment for all groups of individuals living with HIV is essential to attaining epidemic control. About 191,395 children and adolescents under 19 are living with HIV (C/ALHIV) with only 46,461 (24%) on treatment in Nigeria. In order to close this treatment gap, the pediatric ART saturation strategy (PASS), was developed between care and treatment team and orphans and vulnerable children (OVC) team to ensure identification and treatment of C/ALHIV and return of children who were lost-to-follow-up (LTFU) in the cascade of care back to HIV treatment. Methods: We conducted HIV risk assessments for OVC and their households during a six-month intervention period (April-September 2019) in Akwa Ibom, Cross River and Lagos state identifying children at risk for HIV. HIV testing and positive results were compared at 6 months pre-intervention and 6 months post-intervention. Pearson Chi Square test was used to determine the difference between the outcome of pre-intervention and post-intervention groups. One-way ANOVA was used to determine the differences in the means of the HIV testing indicator data between the three states at 95% CI and post-Hoc test (Tukey HSD) was used to determine the differences (P < 0.05).

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“…Yet in other settings, particularly general out-patient services, reaching high PITC coverage has been challenging [7] due to several barriers related to resource limitations including personnel, training, infrastructure and commodities [8]. Thus, clinicians would often practice an informal risk screening, testing only those patients suspected of having AIDS-defining illness or risk behaviors [9]. Additional challenges around consent/guardianship, provider attitudes toward the likelihood of HIV infection, complexities of implementing robust index testing initiatives at scale, and the fact that some children may not be reached by index or other facility-based testing due to health utilization barriers have further limited testing coverage [10][11][12], and widened the treatment gap between children/adolescents and adults.…”

Section: Introductionmentioning

confidence: 99%

Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania

et al. 2021

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To optimize HIV testing resources, programs are moving away from universal testing strategies toward a risk-based screening approach to testing children/adolescents, but there is little consensus around what defines an optimal risk screening tool. This study aimed to validate a 12-item risk screening tool among children and adolescents and provide suggested fewer-item tool options for screening both facility out-patient and community populations by age strata (<10 and ≥10 years). Children/adolescents (2–19 years) with unknown HIV status were recruited from a community-based vulnerable children program and health facilities in 5 regions of Tanzania in 2019. Lay workers administered the screening questions to caregivers/adolescents; nurses enrolled those eligible for the study and tested all participants for HIV. For each screening item, we estimated sensitivity, specificity, positive predictive value and negative predictive value and associated 95% confidence intervals (CI). We generated a score based on the count of items with a positive risk response and fit a receiver operating characteristic curve to determine a cut-off score. Sensitivity, specificity, positive predictive value (PPV; yield) and number needed to test to detect an HIV-positive child (NNT) were estimated for various tool options by age group. We enrolled 21,008 children and adolescents. The proportion of undiagnosed HIV-positive children was low (n = 76; 0.36%; CI:0.29,0.45%). A screening algorithm based on reporting at least one or more items on the 10 to 12-item tool had sensitivity 89.2% (CI:79.1,95.6), specificity 37.5% (CI:36.8,38.2), positive predictive value 0.5% (CI:0.4,0.6) and NNT = 211. An algorithm based on at least two or more items resulted in lower sensitivity (64.6%), improved specificity (69.1%), PPV (0.7%) and NNT = 145. A shorter tool derived from the 10 to 12-item screening tool with a score of “1” or more on the following items: relative died, ever hospitalized, cough, family member with HIV, and sexually active if 10–19 years performed optimally with 85.3% (CI:74.6,92.7) sensitivity, 44.2% (CI:43.5,44.9) specificity, 0.5% (CI:0.4,0.7) PPV and NNT = 193. We propose that different short-tool options (3–5 items) can achieve an optimal balance between reduced HIV testing costs (lower NNT) with acceptable sensitivity. In low prevalence settings, changes in yield may be negligible and NNT may remain high even for an effective tool.

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Effectiveness of symptom-based diagnostic HIV testing versus targeted and blanket provider-initiated testing and counseling among children and adolescents in Cameroon

Cited by 14 publications

References 27 publications

Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities—Nigeria, 2016-2017

Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities—Nigeria, 2016-2017

Closing the Gap in Pediatric HIV Case Finding: A Review of the PASS Strategy in Southern Nigeria

Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania

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