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

Odafe, Solomon; Onotu, Dennis; Fagbamigbe, Johnson Omodele; Ene, Uzoma; Rivadeneira, Emilia; Carpenter, Deborah; Omoigberale, AI; Adamu, Yakubu; Lawani, Ismaïl; James, Ezekiel; Boyd, Andrew T.; Dirlikov, Emilio; Swaminathan, Mahesh

doi:10.1371/journal.pone.0234717

Cited by 8 publications

(8 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 Independently of facility ownership, patients in hospitals were twice more likely to test positive than those in health centers and dispensaries. This is consistent with findings from previous studies [11][12][13] probably because such facilities attend to sicker clientele. Together, these findings suggest that through strengthening HIV testing services in large hospitals and private not-for-profit facilities, along with strengthening targeted outreach to hard-to-reach or underserved populations, more PLWHA can be reached and linked to care who do not yet know their status.…”

Section: Discussionsupporting

confidence: 93%

Reaching 95-95-95 targets: The role of private sector health facilities in closing the HIV detection gap—Kisumu Kenya, 2018

et al. 2022

View full text Add to dashboard Cite

Background HIV testing efficiency could be improved by focusing on high yield populations and identifying types of health facilities where people with undiagnosed HIV infection are more likely to attend. Methods A retrospective cohort analysis of data collected during an integrated TB/HIV active case-finding intervention in Western Kenya. Data were analyzed from health facilities’ registers on individuals who reported TB-suggestive symptoms between 1 July and 31 December 2018 and who had an HIV test result within one month following symptom screening. We used logistic regression with general estimating equations adjusting for sub-county level data to identify health facility-level predictors of new HIV diagnoses. Results Of 11,376 adults with presumptive TB identified in 143 health facilities, 1038 (9%) tested HIV positive. The median HIV positivity per health facility was 6% (IQR = 2–15%). Patients with TB symptoms were over three times as likely to have a new HIV diagnosis in private not-for-profit facilities compared to those in government facilities (adjusted odds ratio (aOR) 3.40; 95% CI = 1.96–5.90). Patients tested in hospitals were over two times as likely to have a new HIV diagnosis as those tested in smaller facilities (i.e., health centers and dispensaries) (aOR 2.26; 95% CI = 1.60–3.21). Conclusion Individuals with presumptive TB who attended larger health facilities and private not-for-profit facilities had a higher likelihood of being newly diagnosed with HIV. Strengthening HIV services at these facilities and outreach to populations that use them could help to close the HIV diagnosis gap.

show abstract

Section: Discussionsupporting

confidence: 93%

Reaching 95-95-95 targets: The role of private sector health facilities in closing the HIV detection gap—Kisumu Kenya, 2018

et al. 2022

View full text Add to dashboard Cite

show abstract

“…In Cameroon and Côte d'Ivoire, high rates of HIV infection were found among siblings/descendants of HIV-positive index patients (22.2%), TB treatment unit attendees (11.4%) and hospitalized children/adolescents (5.6%) 9,11 . Similar results were obtained in Nigeria in which the odds of identifying an HIV-positive child were signi cantly higher in specialized pediatric units and services, including the TB clinic, pediatric inpatient ward, and family index testing, when compared to general outpatient care 12 . The introduction of community-based strategies in addition to facility-based testing can be critical to closing the gap and nding HIV-positive children.…”

Section: Discussionsupporting

confidence: 75%

Optimizing HIV case identification among children and understanding remaining gaps in pediatric HIV testing in Kinshasa, DRC

Ingala¹,

Bakebua²,

Banzadio³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background It is critical to identify children living with HIV and initiate lifesaving treatment early. The Pediatric Accelerated Case Finding Effort focused on line-listing and HIV testing of biological children among HIV-positive clients. We describe HIV testing and seropositivity rates following the initiative and gaps along the pediatric index testing cascade to inform HIV case finding optimization. Methods This mixed-methods study involved collecting monthly data on index testing outcomes, including line-listing (identifying biologic children < 15 years), HIV testing and ART initiation from March 2020 to July 2021 in 35 facilities in Kinshasa. Data were summarized and presented for the first month (as a baseline proxy) and the entire study period. Qualitative data were collected from 14 healthcare workers participating in in-depth interviews and 33 community health workers in four focus group discussions. Audio recordings were transcribed and translated from Lingala or French into English and coded using MAXQDA software. Data were thematically analyzed according pediatric case finding barriers and strategies. Results At baseline, in March 2020, among 3,337 eligible female index clients, 1,634 (49.0%) underwent line-listing to identify children with unknown HIV status. By July 2021, all eligible female index clients (n = 11,734) had a line-list. Of the contacts, 9,871/11,848 (83.3%) were HIV-tested. Of contacts tested, 662 (6.7%) were diagnosed as HIV-positive, with 535 (80.8%) age 5–14 years; 99.5% initiated treatment. Providers attributed gaps in HIV testing primarily to testing refusals for children due to non-disclosure among parents and logistical or financial obstacles to transportation for outreach. COVID-19 movement restrictions and exposure fears also limited provider interactions for testing. Provider-implemented strategies included transport reimbursement, extensive counseling and alternative approaches to child testing for parents in sero-discordant relationships. Conclusion Following intensified efforts around pediatric case finding, we found a high HIV positivity yield of 6.7% among previously undiagnosed children, with 81% of infected children ≥ 5 years. While line-listing improved over time, outreach for HIV testing remained the largest gap, missing an opportunity to reach 17% of undiagnosed children. Ensuring adequate resources for HIV testing and outreach and supporting disclosure among couples, while emphasizing elicitation of ART clients’ biological children can help to optimize pediatric case finding.

show abstract

“…Clinical HIV guidelines in many African settings currently recommend testing all pregnant women, individuals with newly-diagnosed tuberculosis, and all sexually active adults annually and whenever they seek care for a sexually transmitted infection (STI) [ 4 ]—but, risk assessment through screening may be more sensitive and/or specific than this standard of care (SOC). Screening tools have previously been developed for pediatric HIV diagnosis in sub-Saharan Africa [ 12 , 13 ], and may be a useful tool to prioritize high-risk adults for testing. If a screening tool has sufficiently high sensitivity and specificity for HIV infection, it can guide how to use limited testing resources including supplies, staff and space.…”

Section: Introductionmentioning

confidence: 99%

Screening Adults for HIV Testing in the Outpatient Department: An Assessment of Tool Performance in Malawi

Moucheraud

Hoffman

Balakasi³

et al. 2021

AIDS Behav

View full text Add to dashboard Cite

Little is known about screening tools for adults in high HIV burden contexts. We use exit survey data collected at outpatient departments in Malawi (n = 1038) to estimate the sensitivity, specificity, negative and positive predictive values of screening tools that include questions about sexual behavior and use of health services. We compare a full tool (seven relevant questions) to a reduced tool (five questions, excluding sexual behavior measures) and to standard of care (one question, never tested for HIV or tested > 12 months ago). Suspect STI and ≥ 3 sexual partners were associated with HIV positivity, but had weak sensitivity and specificity. The full tool (using the optimal cutoff score of ≥ 3) would achieve 55.6% sensitivity and 84.9% specificity for HIV positivity; the reduced tool (optimal cutoff score ≥ 2) would achieve 59.3% sensitivity and 68.5% specificity; and standard of care 77.8% sensitivity and 47.8% specificity. Screening tools for HIV testing in outpatient departments do not offer clear advantages over standard of care.

show abstract

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

Cited by 8 publications

References 24 publications

Reaching 95-95-95 targets: The role of private sector health facilities in closing the HIV detection gap—Kisumu Kenya, 2018

Reaching 95-95-95 targets: The role of private sector health facilities in closing the HIV detection gap—Kisumu Kenya, 2018

Optimizing HIV case identification among children and understanding remaining gaps in pediatric HIV testing in Kinshasa, DRC

Screening Adults for HIV Testing in the Outpatient Department: An Assessment of Tool Performance in Malawi

Contact Info

Product

Resources

About