Moving Towards Targeted HIV Testing In Older Children Bandason T, McHugh G, Dauya E, Mungofa S,...
If you can't read please download the document
Moving Towards Targeted HIV Testing In Older Children Bandason T, McHugh G, Dauya E, Mungofa S, Kranzer K, Ferrand RA BRTI ZIMA Conference - August 2014
Moving Towards Targeted HIV Testing In Older Children Bandason
T, McHugh G, Dauya E, Mungofa S, Kranzer K, Ferrand RA BRTI ZIMA
Conference - August 2014
Slide 2
2 Background Objectives Methods Results Conclusions
Recommendations Outline of this presentation
Slide 3
Background More than 70% of HIV-infected children undiagnosed 1
and ART coverage lags behind that of adults (46% in Zimbabwe in
2013) 2 Delayed diagnosis and treatment results in not only a high
risk of mortality but also of chronic clinical complications and
disability 3 : Prompt identification essential 3 1 Ferrand RA et al
(2010) 2 Global AIDS Response Country Progress Report, Zimbabwe
2014 3 Ferrand RA et al (2007) Zimbabwe Adults HIV Prevalence -15%
On ART -77%
Slide 4
4 Stunting All patients/guardians consented to pictures 18
years Older Brother aged 17years
Slide 5
Current Testing Strategy WHO 4 recommends PITC for high-burden
settings to facilitate earlier diagnosis Successful implementation
of this strategy in PMTCT program-every pregnant woman offered HIV
testing 5 However, PITC often excludes adolescents: perceived to be
low-risk and testing usually driven only by presence of symptoms 5
4 WHO 2007 PITC Guidelines 5 Global AIDS Response Country Progress
Report, Zimbabwe 2014
Slide 6
Rationale for Targeted HIV Screening Resources not adequate to
test everyone Use of risk scores algorithms proved reliable in
resource limited settings: High sensitivity algorithms widely used
for other diseases e.g Tuberculosis 6 Test accuracy of the proposed
screening algorithm in older children Contribute to the development
of HIV screening guidelines taking into account the HIV prevalence,
resource availability and logistical aspects 6 6 Corbett et al
(2010)
Slide 7
A simple clinical algorithm proposed for screening older
children at risk of HIV infection 7 Admitted to hospital before
Recurring skin problems One or both parents deceased Poor health in
the last 3 months Focuses mainly on children acquiring HIV through
MTCT (Sensitivity of 74% and specificity of 80%) 7 Proposed
Screening algorithm 7 Ferrand et al (2011)
Slide 8
Objective 8 Primary: Validate the performance of algorithm for
screening older children at risk of MCT HIV infection in a primary
care setting Secondary: To detect older children who would benefit
from an HIV test with screening by low cadre healthcare providers
To help reduce the waste of limited resources and allow early HIV
detection and treatment
Slide 9
Methodology Setting 7 Purposively Selected Primary Health Care
polyclinics in southwest Harare Establish HIV treatment services at
clinics to ensure immediate linkage to care and treatment Budiriro
Dzivarasekwa Highfield Kuwadzana Glen View Glen Norah Mufakose
9
Slide 10
Methodology Eligibility Children aged 6-15 years attending for
primary care Not tested within the last 6 months Accompanied by an
appropriate guardian or emancipated youth Consent to an HIV Test
10
Slide 11
Methodology cont. Respond to 4 algorithm questions -has
previously been admitted to hospital - has had recurring skin
problems - is a single or double orphan -has experienced poor
health in the past 3 months. Simple HIV Symptom Score Presence of
screening symptom scores one Max score=4 Ethical approval obtained
from all relevant ethical bodies 11
Slide 12
12 Results: Participant Flow 7,486(57%) ELIGIBLE FOR PITC 6,162
(82%)TESTED 13,046 Children attended PHC 21 st January 2013 31
March 2014 5,560 NOT ELIGIBLE FOR PITC - 1,700 OI Clinic
Consultation - 1,939 no guardian - 1,117 Tested -ve in the last 6
months - 804 Inappropriate guardian 1,324 NOT TESTED - 604 Refused
Testing - 720 Other Reasons 6,102 (99%) SELECTED FOR THE ALGORITHM
VALIDATION 60 DID NOT RESPOND TO ALL/SOME ALGORITHM QUESTIONS
Slide 13
13 Baseline Characteristics (N=6,012) Median age 9 years (IQR 7
-11 years) Male 3,138 (51.4%) HIV Positive 290 (4.8%) Past hospital
admission585 (9.6%) Had recurring skin problems 995 (16.3%) One or
both parents deceased 899 (14.7%) Poor health in the last 3 months
493 (8.1%) Algorithm score 1 1,609 (26.4%) Algorithm score 2 489
(8.0%) Algorithm score 3 96 (1.6%) Algorithm score 4 16 (0.3%)
