Evaluation of integrated registers for tuberculosis and HIV surveillance in children, Ethiopia, 2007–2009 [Notes from the field]

Es, Click; Feleke, Beniam; Pevzner, Eric; Fantu, Ribka; Gadisa, Tsigereda; Assefa, Dawit; Melaku, Zenebe; Cain, Kevin P.; Menzies, Heather

doi:10.5588/ijtld.11.0655

Cited by 4 publications

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“…The high prevalence in TB clinics in our study (7.9%) is consistent with studies from high-prevalence countries (6%–56%) 3,5 but is lower than a previous study from Ethiopia (12%). 4 Although one study in Zimbabwe (a high-prevalence country) found yields up to 18% among OVC <5 years, 11 OVC does not appear high yield in Ethiopia (yield, 0.3%). Some studies from high-prevalence countries focused on children <5 years, 2,11 while our population included children up to 14 years, which may have contributed to the differences in the OVC and malnutrition entry points.…”

Section: Discussionmentioning

confidence: 97%

“…Minimum sample size was determined for each of the five entry points by considering client load and number of children tested during the prior fiscal year and assumed pediatric HIV prevalence by entry point from published literature 4 and program data from facilities and implementing partners (Text, Supplemental Digital Content 1, http://links.lww.com/INF/E518, and Table, Supplemental Digital Content 2, http://links.lww.com/INF/E519, respectively). For the OVC entry point, each study facility had an OVC program that referred children for facility-based testing.…”

Section: Sample Sizementioning

confidence: 99%

“…1 ART coverage in Ethiopia is lower in children than adults (48% vs 76%), 1 mainly due to challenges with pediatric case identification. Studies in high-prevalence Sub-Saharan African countries have shown high HIV positivity among children who are malnourished, 2 diagnosed with tuberculosis (TB), 3–5 and admitted to inpatient wards. 2,6–8 Other studies have indicated high HIV prevalence among children of HIV-positive mothers 6,9,10 and orphans and vulnerable children (OVC).…”

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confidence: 99%

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Finding Children Living With HIV in Low-prevalence Countries

Hrapcak

Bekele²,

Ahmed

et al. 2021

Pediatric Infectious Disease Journal

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Background: Limited data in low HIV prevalence settings such as Ethiopia limit policy development and implementation of optimized pediatric testing approaches to close the treatment gap. This study aimed to determine HIV prevalence, testing yield and factors associated with HIV among children at 5 entry points. Methods: We conducted a cross-sectional study from May 2017 to March 2018 in 29 public health facilities in Amhara and Addis Ababa regions in Ethiopia. Children 2-14 years were enrolled through 5 entry points. Data were obtained from registers, medical records and interviews with caregivers. HIV prevalence and testing yields were calculated for each entry point. Mixed-effects logistic regression analysis identified factors associated with undiagnosed HIV. Results:The study enrolled 2166 children, of whom 94 were HIV positive (40 newly diagnosed). HIV prevalence and testing yield were the highest among children of HIV-positive adults (index testing; 8.2% and 8.2%, respectively) and children presenting to tuberculosis clinics (7.9% and 1.8%) or with severe malnutrition (6.5% and 1.4%). Factors associated with undiagnosed HIV included tuberculosis or index entry point [adjusted odds ratio (aOR), 11.97; 95% CI 5.06-28.36], deceased mother (aOR 4.55; 95% CI 1.30-15.92), recurrent skin problems (aOR 17.71; 95% CI 7.75-40.43), severe malnutrition (aOR 4.56; 95% CI 2.04-10.19) and urban residence (aOR 3.47; 95% CI 1.03-11.66). Conclusions: Index testing is a critical strategy for pediatric case finding in Ethiopia. Strategies and resources can prioritize minimizing missed opportunities in implementing universal testing for very sick children (tuberculosis, severe malnutrition) and implementing targeted testing in other entry points through use of factors associated with HIV.

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Section: Discussionmentioning

confidence: 97%

Section: Sample Sizementioning

confidence: 99%

mentioning

confidence: 99%

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Finding Children Living With HIV in Low-prevalence Countries

Hrapcak

Bekele²,

Ahmed

et al. 2021

Pediatric Infectious Disease Journal

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Enhancing HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention in the United States Through Program Collaboration and Service Integration

Steiner¹,

Aquino²,

Fenton³

2013

Sexually Transmitted Diseases

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HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis in the United States remain major public health concerns. The current disease-specific prevention approach oftentimes has led to narrow success and missed opportunities for increasing program capacity, leveraging resources, addressing social and structural determinants, and accelerating health impact-suggesting a need for greater innovation to prevent related diseases. The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's Program Collaboration and Service Integration (PCSI) strategic priority aims to strengthen collaborative engagement across these disease areas and to integrate services at the client level. In this review, we articulate the 5 principles of PCSI-appropriateness, effectiveness, flexibility, accountability, and acceptability. Drawing upon these principles and published literature, we discuss the case for change that underlies PCSI, summarize advances in the field since 2007, and articulate key next steps. Although formal evaluation is needed to fully assess the health impact of PCSI, available evidence suggests that this approach is a promising tool to advance prevention goals.

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Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk screening tool for testing children presenting at high-risk entry points in Ethiopia

et al. 2022

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Background Implementing effective and efficient case-finding strategies is crucial to increasing pediatric antiretroviral therapy coverage. In Ethiopia, universal HIV testing is conducted for children presenting at high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC); however, low positivity rates observed at inpatient, malnutrition and OVC entry points warrant re-assessing current case-finding strategies. The aim of this study is to develop HIV risk screening tool applicable for testing children presenting at inpatient, malnutrition and OVC entry points in low-HIV prevalence settings. Methods The study was conducted from May 2017–March 2018 at 29 public health facilities in Amhara and Addis Ababa regions of Ethiopia. All children 2–14 years presenting to five high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC) were enrolled after consent. Data were collected from registers, medical records, and caregiver interviews. Screening tools were constructed using predictors of HIV positivity as screening items by applying both logistic regression and an unweighted method. Sensitivity, specificity and number needed to test (NNT) to identify one new child living with HIV (CLHIV) were estimated for each tool. Results The screening tools had similar sensitivity of 95%. However, the specificities of tools produced by logistic regression methods (61.4 and 65.6%) which are practically applicable were higher than those achieved by the unweighted method (53.6). Applying these tools could result in 58‒63% reduction in the NNT compared to universal testing approach while maintaining the overall number of CLHIV identified. Conclusion The screening tools developed using logistic regression method could significantly improve HIV testing efficiency among children presenting to malnutrition, inpatient, and OVC entry points in Ethiopia while maintaining case identification. These tools are simplified to practically implement and can potentially be validated for use at various entry points. HIV programs in low-prevalence countries can also further investigate and optimize these tools in their settings.

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Evaluation of integrated registers for tuberculosis and HIV surveillance in children, Ethiopia, 2007–2009 [Notes from the field]

Cited by 4 publications

References 1 publication

Finding Children Living With HIV in Low-prevalence Countries

Finding Children Living With HIV in Low-prevalence Countries

Enhancing HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention in the United States Through Program Collaboration and Service Integration

Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk screening tool for testing children presenting at high-risk entry points in Ethiopia

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