Implementation and Operational Research: Active Referral of Children of HIV-Positive Adults Reveals High Prevalence of Undiagnosed HIV

January 2017 - Structural Prevention

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Wagner, A.D., Mugo, C., Njuguna, I.N., et al. Journal of Acquired Immune Deficiency Syndromes (December 2016), 73(5):e83–e89. doi:10.1097/QAI.0000000000001184.

This prospective cohort study in Kenya evaluated uptake of an HIV intervention to determine if testing young children of HIV-positive adults can help identify undiagnosed HIV-positive children. Caregivers were eligible if they were HIV-positive and had at least one child ≤12 years of unknown HIV status. During the intervention period (2013–2014), 10,426 HIV-positive adults enrolled in a treatment program were interviewed. Of these, 3,477 (42%) had children of unknown HIV status, and 611 (7%) children under age 12; 116 adults in this category enrolled. These parents were given the choice of home-based, clinic-based, or no HIV testing for their children. This differed from the standard of care, in which health care workers may or may not determine if the client had children who should be referred. Among the 116 parents of younger children, 74 (64%) had 108 children tested. Results showed that this "active" referral for testing identified a large number of untested older children and increased pediatric HIV testing rates (from 3.5 to 13.6 children tested per month). HIV prevalence among the tested children was 7.4 percent—higher than in the general population (1%) and higher than estimated for early infant diagnosis programs with prevention of mother-to-child transmission (1–3%). However, only 14 percent of caregivers in the study tested their children.

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