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. 2023 Feb 1;42(2):110-118.
doi: 10.1097/INF.0000000000003778. Epub 2022 Nov 23.

Considerations to Improve Pediatric HIV Testing and Close the Treatment Gap in 16 African Countries

Jessica Gross  1 , Amy Medley  1 , Emilia Rivadeneira  1 , Katherine Battey  1 , Meena Srivastava  2 , Michael Grillo  3 , Hilary Wolf  4 , Paige Simmons  5 , Marisa Hast  1 , Monita Patel  1 ; National HIV Testing Workgroup
Collaborators, Affiliations

Considerations to Improve Pediatric HIV Testing and Close the Treatment Gap in 16 African Countries

Jessica Gross et al. Pediatr Infect Dis J. .

Abstract

Background: In 2019, South Africa, Nigeria, Tanzania, Democratic Republic of Congo, Uganda, Mozambique, Zambia, Angola, Cameroon, Zimbabwe, Ghana, Ethiopia, Malawi, Kenya, South Sudan and Côte d'Ivoire accounted for 80% of children living with HIV (CLHIV) not receiving HIV treatment. This manuscript describes pediatric HIV testing to inform case-finding strategies.

Methods: We analyzed US President's Emergency Plan for AIDS Relief monitoring, evaluation, and reporting data (October 1, 2018 to September 30, 2019) for these 16 countries. Number of HIV tests and positive results were reported by age band, country, treatment coverage and testing modality. The number needed to test (NNT) to identify 1 new CLHIV 1-14 years was measured by testing modality and country. The pediatric testing gap was estimated by multiplying the estimated number of CLHIV unaware of their status by NNT per country.

Results: Among children, 6,961,225 HIV tests were conducted, and 101,762 CLHIV were identified (NNT 68), meeting 17.6% of the pediatric testing need. Index testing accounted for 13.0% of HIV tests (29.7% of positive results, NNT 30), provider-initiated testing and counseling 65.9% of tests (43.6% of positives, NNT 103), and universal testing at sick entry points 5.3% of tests (6.5% of positives, NNT 58).

Conclusions: As countries near HIV epidemic control for adults, the need to increase pediatric testing continues. Each testing modality - PITC, universal testing at sick entry points, and index testing - offers unique benefits. These results illustrate the comparative advantages of including a strategic mix of testing modalities in national programs to increase pediatric HIV case finding.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Number of HIV tests and positive results from index testing and all other modalities and the proportion of HIV tests and positive results from index testing among children– by country¥, October 1, 2018 to September 30, 2019. ¥Results for proportion of HIV tests and positive results through index testing for Ethiopia need to be cautiously interpreted because most HIV tests and results in outpatient entry points were not reported in FY19; Geographic coverage for PEPFAR DRC includes support for 3 of 26 provinces.
FIGURE 2.
FIGURE 2.
Number of children that programs needed to test (NNT) to identify 1 positive child by modality and country, October 1, 2018 to September 30, 2019∂. ∂Lines represent overall NNT by modality for pooled data from all countries. Results for outpatient department testing in Ethiopia need to be cautiously interpreted because most HIV tests and results in outpatient entry points were not reported in FY19; geographic coverage for PEPFAR DRC includes support for 3 of 26 provinces.
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