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Family Testing: An Index Case Finding Strategy to Close the Gaps in Pediatric HIV Diagnosis
Katherine R Simon1,2, Robert J Flick1, Maria H Kim1,2
1Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
Insights
Family testing is a crucial strategy to find undiagnosed children with HIV, connecting them to early antiretroviral therapy. This approach efficiently identifies at-risk children through systematic screening of infected adults, improving pediatric HIV case finding.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- HIV/AIDS epidemiology
Background:
- Many children with HIV remain undiagnosed, missing vital antiretroviral therapy.
- Children of HIV-infected adults are at high risk but often lack access to testing.
- Existing case-finding programs have missed opportunities for pediatric HIV diagnosis.
Purpose of the Study:
- To review the evidence supporting family testing for pediatric HIV case finding.
- To describe challenges in implementing family testing strategies.
- To provide guidance for integrating family testing into health systems.
Main Methods:
- Systematic screening of HIV-infected patients to identify family members with unknown HIV status.
- Targeting high-risk populations for efficient case identification.
- Review of existing evidence and program implementation.
Main Results:
- Family testing is a pragmatic, high-yield approach for identifying undiagnosed HIV-infected children.
- This strategy links children to care before symptom onset.
- Implementation and guideline incorporation of family testing are variable.
Conclusions:
- Family testing is an effective strategy to improve pediatric HIV diagnosis and treatment access.
- Addressing implementation challenges is key to widespread adoption.
- Guidance and tools are needed for health systems to integrate family testing.
Abstract:
Despite significant advances in pediatric HIV treatment, too many children remain undiagnosed and thus without access to lifesaving antiretroviral therapy. It is critical to identify these children and initiate antiretroviral therapy as early as possible. Although the children of HIV-infected adults are at higher risk of infection, few access HIV testing services because of missed opportunities in existing case finding programs. Family testing is an index case finding strategy through which HIV-infected patients are systematically screened to identify family members with unknown HIV status. By specifically targeting a high-risk population, family testing is a pragmatic, high-yield, and efficient approach to identify previously undiagnosed HIV-infected children and link them to care before they become symptomatic. Despite this, incorporation of family testing into national guidelines and implementation of this case finding approach is variable. In this article, we review the evidence base for family testing, describe its challenges, and provide guidance and sample tools for program managers aiming to integrate family testing into existing health systems.
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