Volume and yield of pediatric HIV testing by modality in 21 PEPFAR-supported African programs
Background: Case-finding
for children living with HIV (CLHIV) remains suboptimal, contributing to
persistently lower antiretroviral treatment (ART) coverage for children (< 15
years old).
Methods: Volumes and positivity rates of HIV testing for children in
PEPFAR-supported programs in Africa during 2017 (fiscal year) were analyzed
overall and by four modalities: inpatient wards, index testing, outpatient
departments (OPD) and tuberculosis (TB) clinic. Early infant virologic diagnostic testing was
excluded. Total testing exceeds the sum of the four selected modalities because
we did not break out test results reported under modalities that were difficult
to characterize for children (e.g, voluntary testing and counseling) or that
were not primarily case-finding channels (eg, pre-circumcision testing). Results
from Ghana were excluded because they were incomplete.
Results: HIV
testing volume (volume), contribution to overall testing volume (% of Volume),
positivity rates (POS rate), and contribution to country program positive
results varied widely across the 21 country programs [Table]. In most countries, OPD testing contributed
the greatest testing volume testing (51.5%) and cases identified (48.3%);
however, on average, the OPD positivity rate (1.6%) was lower than the positivity
rate overall (1.9%) and for all other modalities: inpatient, 2.0%; index, 4.8%;
TB, 5.0%. While TB positivity rates were high in many countries, it accounted
for < 2% of testing volumes (except 5% for South Sudan) and contributed < 6%
of case-finding. Inpatient POS rate was < 5% for all countries except
Botswana (6.3%). While index testing POS
rates varied greatly, they were as high or higher than the overall POS rate for
all but 3 countries (South Africa, Swaziland, Zambia) and accounted for >10%
of new cases in 12 countries including >20% of all new cases in six
countries.
Conclusions: Tracking pediatric testing results overall and by modality
can help countries adjust testing programs to optimize identification and
treatment of CLHIV. Inpatient testing remains an important but declining source
of case identification. Index testing has variable yield that may reflect whether
testing is limited to biologic children of parents with HIV; scaling this
approach with fidelity is a key strategy for finding children in all settings.
[Table]
G. Siberry1, J. Roffenbender2
1US Department of State, Office of the Global AIDS Coordinator, Rockville, United States, 2US Department of State, Office of the Global AIDS Coordinator (PEPFAR), Washington, United States