Addressing the Challenges and Relational Aspects of Index-Linked HIV testing for Children and Adolescents: Insights From The B-GAP Study in Zimbabwe

Abstract

Introduction Index-linked HIV testing, targeted at sexual contacts or children of individuals with HIV, may improve yield and efficiency. The B-GAP study evaluated index-linked testing approaches in health facility and community-based settings. This paper reports on a qualitative study to understand factors that affect index-linked HIV testing for children and adolescents.Methods We conducted four focus group discussions (FGDs) with caregivers who had their children tested through B-GAP and one FGD with providers who offered index-linked HIV testing to indexes. We aimed to understand enabling and inhibiting factors in the decision-making process. Translated and transcribed transcripts were read for familiarisation. Following initial coding, analytical memos were written to identify emerging key themes across the data.Results Caregivers did not have adequate knowledge about the need for, and importance of, paediatric HIV testing. Once the decision to test had been made, access to facilities was sometimes challenging, and alleviated by community-based testing. A key finding was that HIV testing is not a discrete event but a process that was influenced by relationships with other family members and children themselves. These relationships raised complex issues that could prevent or delay the testing process. Conclusion There is a need to improve paediatric HIV literacy and to provide support to caregivers and their families in order to improve testing uptake. Addressing access barriers through the provision of community-based testing and implementing a family centred approach can optimize index-linked testing. Contributions to the literature • Although promoted and recommended by the World Health Organization; index-linked HIV testing for children has not been standard practice in routine HIV care for many countries including Zimbabwe.• Prior this study, no study has evaluated the factors that influence and affect uptake of index-linked HIV testing for children and adolescents as reported in our manuscript. • Our findings have the potential to bridge the HIV testing gap for children and optimize index-linked testing, a strategy that has been shown to result in higher yield of HIV when compared to universal testing but where uptake remains suboptimal.