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Implementation and Operational Research: The Effectiveness of Routine Opt-Out HIV Testing for Children in Harare,
Rashida Abbas Ferrand1, Jamilah Meghji, Khameer Kidia
1*Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom;†Department of Clinical Research, Biomedical Research and Training Institute, Harare, Zimbabwe;‡Department of Pediatrics, University of Zimbabwe, Harare, Zimbabwe;§Department of AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe;‖Harare City Health Department, Harare, Zimbabwe; and¶Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Insights
Routine opt-out HIV testing (ROOT) significantly increased HIV testing rates and diagnoses in children aged 6-15 years compared to provider-initiated testing and counseling (PITC). This approach effectively reduces missed HIV diagnoses in pediatric primary care.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- HIV/AIDS Research
Background:
- HIV testing is crucial for accessing care, but many children remain undiagnosed until symptomatic.
- Conventional provider-initiated testing and counseling (PITC) has limitations in identifying HIV in pediatric populations.
- Early diagnosis in children is essential for effective HIV management and improved outcomes.
Purpose of the Study:
- To compare the effectiveness of routine opt-out HIV testing (ROOT) versus PITC for children in primary care.
- To evaluate the impact of ROOT on HIV testing rates, uptake, and diagnosis yield in children aged 6-15 years.
- To determine if ROOT can reduce missed HIV diagnoses in pediatric patients.
Main Methods:
- A pre-post intervention study comparing PITC and ROOT strategies in 6 primary health care facilities in Harare, Zimbabwe.
- Evaluation of changes in the proportion of eligible children offered and receiving HIV tests.
- Analysis of HIV diagnosis yield and adjusted risk ratios for testing under ROOT versus PITC.
Main Results:
- The proportion of eligible children offered testing increased from 76% to 93% with ROOT.
- HIV test uptake improved significantly, from 71% to 95% under the ROOT strategy.
- The yield of HIV-positive diagnoses increased from 2.9% to 4.5%, with ROOT showing a 1.99 increased adjusted risk of testing.
Conclusions:
- Routine opt-out HIV testing (ROOT) is more effective than PITC in increasing HIV testing coverage among children.
- ROOT leads to a higher yield of HIV diagnoses, addressing missed opportunities for early detection.
- The ROOT strategy offers a valuable approach to reduce undiagnosed HIV infections in children attending primary care.
Objective:
HIV testing is the entry point to access HIV care. For HIV-infected children who survive infancy undiagnosed, diagnosis usually occurs on presentation to health care services. We investigated the effectiveness of routine opt-out HIV testing (ROOT) compared with conventional opt-in provider-initiated testing and counseling (PITC) for children attending primary care clinics.
Methods:
After an evaluation of PITC services for children aged 6-15 years in 6 primary health care facilities in Harare, Zimbabwe, ROOT was introduced through a combination of interventions. The change in the proportion of eligible children offered and receiving HIV tests, reasons for not testing, and yield of HIV-positive diagnoses were compared between the 2 HIV testing strategies. Adjusted risk ratios for having an HIV test in the ROOT compared with the PITC period were calculated.
Results:
There were 2831 and 7842 children eligible for HIV testing before and after the introduction of ROOT. The proportion of eligible children offered testing increased from 76% to 93% and test uptake improved from 71% to 95% in the ROOT compared with the PITC period. The yield of HIV diagnoses increased from 2.9% to 4.5%, and a child attending the clinics post intervention had a 1.99 increased adjusted risk (95% CI: 1.85 to 2.14) of receiving an HIV test in the ROOT period compared with the preintervention period.
Conclusion:
ROOT increased the proportion of children undergoing HIV testing, resulting in an overall increased yield of positive diagnoses, compared with PITC. ROOT provides an effective approach to reduce missed HIV diagnosis in this age group.
