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Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from
Jane N Mutanga1, Juliette Raymond, Megan S Towle
1Livingstone General Hospital, Livingstone, Zambia.
Insights
Provider-initiated testing and counselling (PITC) significantly increased HIV testing and care access for children in Zambia. This strategy proved effective in identifying and enrolling infected children into care, demonstrating its feasibility in high-prevalence settings.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- HIV/AIDS Management
Background:
- Provider-initiated testing and counselling (PITC) is crucial for pediatric HIV prevention and treatment access.
- Scaling up PITC in resource-limited settings presents unique challenges and opportunities.
- This study focuses on implementing PITC at a second-level hospital in Zambia's Southern Province.
Purpose of the Study:
- To examine the best practices and enabling factors for rapid institutionalization of pediatric PITC.
- To assess the impact of PITC on HIV testing uptake and linkage to care for children.
- To inform strategies for scaling up PITC in similar healthcare settings.
Main Methods:
- Retrospective case study of Livingstone General Hospital's PITC program.
- Inclusion of clinical observations, key informant interviews, and hospital management information system data review.
- Analysis of PITC uptake, HIV diagnosis rates, and linkage to care over a 36-month period.
Main Results:
- PITC resulted in high testing uptake: 98.2% of eligible children tested.
- 15.5% of tested children were HIV-infected, with 77.6% diagnosed via DNA PCR for infants under 18 months.
- 99.3% of identified HIV-infected children were enrolled in care, including prophylaxis and antiretroviral therapy initiation.
Conclusions:
- Institutional PITC is a feasible and effective strategy for expanding pediatric HIV care access.
- Key operational practices include dedicated nurse counselors, task-shifting, and integrated on-site services.
- Successful implementation enhances early infant diagnosis and the continuum of care for children and families.
Background:
Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia's Southern Province, and serving a catchment area of 1.2 million people.
Methods And Principal Findings:
Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983), 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital's inpatient and outpatient departments (n = 1342), 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early infant diagnosis. The hospital's bolstered antiretroviral supply chain, package of on-site HIV services, and follow-up care for children and families improved the continuum of service uptake.
Conclusions And Significance:
The clinical impact and operational experience emphasizes that institutional PITC is a feasible strategy for increasing access to paediatric HIV care, particularly in generalized epidemic settings.
