Where are the children? Case finding in 5–14-year-olds living with HIV in Johannesburg

Dunlop, J.; Tait, Carol L.; Mabitsi, Moyahabo; Rees, K. R.

doi:10.4102/sajhivmed.v23i1.1378

Cited by 2 publications

(6 citation statements)

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“…This raises the need to focus on school-aged children who are not often targeted by health programs. Evidence from other countries, such as South Africa and Malawi, revealed challenges with elicitation and testing of biological children, with almost half of clients living with HIV enrolled in treatment services had untested household members [ 5 , 8 ] and up to 81% of children of adult ART clients were reportedly not tested for HIV. Older children 9–14 years were the least likely to be tested compared to younger children [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

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

Ingala,

Bakebua,

Banzadio

et al. 2024

BMC Pediatr

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Background It is critical to identify children living with HIV and initiate lifesaving antiretroviral treatment (ART) early. The Pediatric Accelerated Case Finding Effort focused on contact elicitation and HIV testing of ART clients’ biological children. We describe HIV testing and seropositivity rates following the initiative and gaps along the index testing cascade to inform pediatric HIV case finding optimization. Methods This mixed-methods study involved collecting monthly data on index testing outcomes, including elicitation (identifying biological children < 15 years), HIV testing and linkage to treatment 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 (March 2020), among 3337 eligible female index clients, 1634 (49.0%) underwent elicitation to identify children with unknown HIV status. By July 2021, all eligible clients (n = 11,734) had contacts identified. Of the contacts, 9871/11,848 (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 tracing. 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. Conclusions Following intensified efforts around pediatric case finding, we found a high HIV positivity yield of 6.7% among previously undiagnosed children, with 81% of them aged ≥5 years. While elicitation improved over time, contact tracing for HIV testing remained the largest gap, missing opportunities to reach 17% of undiagnosed children. Ensuring adequate resources for tracing and HIV testing and supporting disclosure among couples, while emphasizing elicitation of ART clients’ biological children can help to optimize pediatric case finding.

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Section: Discussionmentioning

confidence: 99%

“…Despite efforts to close this gap, CLHIV aged 5–14 years are likely missed more frequently than younger children, once they age-out of under five-focused health services. Expansion of case finding strategies and targeted approaches are needed in this age group [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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

Ingala,

Bakebua,

Banzadio

et al. 2024

BMC Pediatr

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“…This raises the need to focus on school-aged children who are not often targeted by health programs. Evidence from other countries, such as South Africa and Malawi, revealed challenges with line-listing and testing of biological children, with almost half of HIV-positive clients enrolled in treatment services had untested household members 5,8 and up to 81% of children of adult ART clients were reportedly not tested for HIV. Older children 9-14 years were the least likely to be tested compared to younger children 4,5 .…”

Section: Discussionmentioning

confidence: 99%

“…Qualitative data from providers suggests one reason for this is fear of HIV status disclosure among index HIV-positive women. Index clients' fear of negative consequences for having their children tested may result in inadvertent disclosure of maternal status, which can lead to intimate partner violence or other harms for the mother and her child 5 . While continued counseling was offered as a strategy by a few providers in our study, short-term solutions were also described to arrange for HIV testing without the non-index client parent's knowledge.…”

Section: Discussionmentioning

confidence: 99%

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

Ingala¹,

Bakebua²,

Banzadio³

et al. 2023

Preprint

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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.

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Where are the children? Case finding in 5–14-year-olds living with HIV in Johannesburg

Abstract: No abstract available.

Cited by 2 publications

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

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

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

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