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Data from: They are likely to be there: using a family-centered index-testing approach to identify HIV-positive children in Kenya Lewis-Kulzer, Jayne; Okoko, Nicollate; Ohe, Kirsten; Mburu, Margaret; Muttai, Hellen; Abuogi, Lisa; Bukusi, Elizabeth; Cohen, Craig; Penner, Jeremy

Description

Abstract

In Kenya, only half of children with an HIV-positive parent have been tested for HIV. The effectiveness of a family-centred index-testing approach to identify children (0-14 years) living with HIV was examined.  A retrospective clinical record review was conducted among adult index patients newly enrolled in HIV care between May–July 2015 and family outcomes were followed through May 2016 at 60 high-volume clinics in western Kenya. HIV testing uptake and results, health facility level, enrollment into care and antiretroviral therapy (ART) initiation were abstracted. Chi-square test compared yield (percentage of HIV tests positive) among children tested through family-centred index testing to outpatient and inpatient testing approaches for the same age category, health facilities and time period. Review of 1,937 index client charts led to the identification of 3,005 eligible children for testing. Of 2,848 (94.8%) children tested through family-centred index testing, 127 (4.5%) were HIV-positive, 100 (78.7%) were linked to care, and 85 of those eligible (91.4%) had initiated ART by May 2016. Family testing resulted in higher yield as compared with inpatient 1.8% (p<0.001) or outpatient testing 1.6% (p<0.001).    The absolute number of HIV positive children identified, however, was highest with outpatient testing (338 HIV positive children identified out of 27,402 tested). The family testing approach resulted in a high HIV identification yield for children and demonstrated promise in achieving the first two 90’s of the 90-90-90 targets for children, with additional effort required to improve linkage from testing to treatment.

; Methods

This retrospective review of clinical records among clients newly enrolled in HIV care at 60 high-volume MOH health facilities, used a convenience sample based on feasibility across three high-burden counties in western Kenya (Kisumu, Homabay, and Migori). This included all index clients who enrolled in HIV care between May and July 2015 and followed them for a minimum of 10 months through May 2016. Index clients’ and contacts’ patient medical record data were abstracted, including testing eligibility of children contacts (known positives were not eligible; those with previously negative test results were eligible if due for retesting per national guidelines), testing status, HIV identification, enrollment into care for those identified with HIV, and ART initiation for those eligible for ART according to the national guidelines at the time (ART was recommended for all children 10 years and below, however was based on CD4 count and clinical staging for those above 10 years) (17).

To compare the family testing approach to other PITC approaches for children, abstracted aggregate data on HIV testing and identification of children from routine MOH outpatient and inpatient reports at the same health facilities during the same enrollment period as the family testing cohort period: May 2015 – July 2015, were compared. Abstracted aggregate data using MOH-designated facility level of testing sites: level 4 (county and sub-county hospitals); level 3 (health centers); and level 2 (dispensaries) were also compared (18).

Descriptive statistics were generated and Chi-square testing was conducted to compare the HIV testing yield between the family testing, outpatient and inpatient testing approaches. Statistical analysis was performed with STATA version 12.0 (StateCorp, College Station, TX).

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