Stool Xpert had similar performance compared with sputum/gastric aspirate Xpert to detect TB. Urine LAM had lower sensitivity and specificity, but increased among children with severe immunosuppression. Stool Xpert and urine LAM can aid rapid detection of TB in HIV-infected children using easily accessible samples.

National Institute of Child Health and Human Development, National Institutes of Health, USA.

Objectives Few routine systems exist to test older, asymptomatic children for HIV. Testing all children in the population has high uptake but is inefficient, while testing only symptomatic children increases efficiency but misses opportunities to optimize outcomes. Testing children of HIV-infected adults in care may efficiently identify previously undiagnosed HIV-infected children before symptomatic disease. Methods HIV-infected parents in HIV care in Nairobi, Kenya were systematically asked about their children’s HIV status and testing history. Adults with untested children ≤12 years old were actively referred and offered the choice of pediatric HIV testing at home or clinic. Testing uptake and HIV prevalence were determined, as were bottlenecks in pediatric HIV testing cascade. Results Of 10,426 HIV-infected adults interviewed, 8,287 reported having children, of whom 3,477 (42%) had children of unknown HIV status, and 611 (7%) had children ≤12 years of unknown HIV status. Following implementation of active referral, the rate of pediatric HIV testing increased 3.8-fold from 3.5 to 13.6 children tested per month, (RR: 3.8, 95%CI: 2.3–6.1). Of 611 eligible adults, 279 (48%) accepted referral and were screened, and 74 (14%) adults completed testing of 1 or more children. HIV prevalence among 108 tested children was 7.4% and median age was 8 years (IQR: 2–11); one child was symptomatic at testing. Conclusions Referring HIV-infected parents in care to have their children tested revealed many untested children and significantly increased the rate of pediatric testing; prevalence of HIV was high. However, despite increases in pediatric testing, most adults did not complete testing of their children.

Objectives: To determine clinic-level and individual-level correlates of viral suppression among HIV-positive adolescents and young adult (AYA) aged 10–24 years receiving antiretroviral treatment (ART). Design: Multilevel cross-sectional analysis using viral load data and facility surveys from HIV treatment programs throughout Kenya. Methods: We abstracted medical records of AYA in HIV care, analyzed the subset on ART for more than 6 months between January 2016 and December 2017, and collected information on services at each clinic. Multilevel logistic regression models were used to determine correlates of viral suppression at most recent assessment. Results: In 99 HIV clinics, among 10 096 AYA on ART more than 6 months, 2683 (27%) had unsuppressed viral load at last test. Among 16% of clinics, more than 80% of AYA were virally suppressed. Clinic-level correlates of individual viral suppression included designated adolescent spaces [aOR: 1.32, 95% CI (1.07–1.63)] and faster viral load turnaround time [aOR: 1.06 (95% CI 1.03–1.09)]. Adjusting for clinic-level factors, AYA aged 10–14 and 15–19 years had lower odds of viral suppression compared with AYA aged 20–24 years [aOR: 0.61 (0.54–0.69) and 0.59 (0.52–0.67], respectively. Compared with female patients, male patients had lower odds of viral suppression [aOR: 0.69 (0.62–0.77)]. Compared with ART duration of 6–12 months, ART for 2–5, above 5–10 or more than 10 years was associated with poor viral suppression (P < 0.001). Conclusion: Dedicated adolescent space, rapid viral load turnaround time, and tailored approaches for male individuals and perinatally infected AYA may improve viral suppression. Routine summarization of viral load suppression in clinics could provide benchmarking to motivate innovations in clinic-AYA and individual-AYA care strategies.

Objectives Determine whether continuous quality improvement (CQI) improves quality of HIV testing services (HTS) for adolescents and young adults (AYA). Design CQI was introduced at 2 HIV testing settings: Youth Centre (YC) and Voluntary Counseling and Testing (VCT) at a national referral hospital in Nairobi, Kenya. Methods Primary outcomes were AYA satisfaction with HTS, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T-tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. Results There were 172 AYA (YC=109; VCT=63) during 6 baseline weeks and 702 (YC=454; VCT=248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at YC: 18% vs 63%, adjusted risk difference (aRD)=0.42 (95%CI: 0.21–0.63), and a trend at VCT: 38% vs 72%, aRD=0.30 (95%CI: −0.04–0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46% vs 61%, aRD=0.39 (95%CI: 0.02–0.76), but not YC (p=0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs 4.3; aRD: 0.78 [95%CI: −0.11–1.67]) but not at YC (p=0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (p=0.384, p=0.755). HCW satisfaction remained high during intervention and baseline (p=0.746). Conclusions CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.