Developing and Validating an Effective Pediatric and Adolescent HIV Testing Eligibility Screening Tool for...

Area of Science:

• Pediatric infectious diseases
• Epidemiology
• Public health

Background:

• Pediatric HIV testing is less efficient than adult testing due to low prevalence.
• The number needed to test (NNT) for pediatric HIV in Uganda is high, particularly in outpatient departments (OPDs).
• Optimizing pediatric HIV testing strategies is crucial for early detection and intervention.

Purpose of the Study:

• To develop and validate a pediatric screening tool for Human Immunodeficiency Virus (HIV) in children aged 1.5-14 years.
• To enhance the efficiency and yield of pediatric HIV testing approaches.
• To reduce the number needed to test (NNT) for identifying HIV-positive children.

Main Methods:

• Phase 1: Evaluated 10 screening questions in 14 OPDs using variable selection and logistic regression to identify optimal predictive combinations.
• Phase 2: Validated the proposed tool in 15 OPDs and 7 orphan and vulnerable children programs.
• Estimated sensitivity, specificity, and NNT, accounting for intercluster correlations.

Main Results:

• The optimal screening tool included maternal HIV status or 2 of 5 key symptoms (sickly, recurring skin problems, weight loss, poor growth, TB history).
• The tool demonstrated high sensitivity (83.6%-88.1%) and reasonable specificity (62.5%-69.0%) across various settings.
• Validated NNT was 43 overall and 28 in OPDs, indicating improved testing efficiency.

Conclusions:

• A validated pediatric HIV screening tool exhibits high sensitivity and acceptable specificity.
• This tool significantly increases testing efficiency and yield for pediatric HIV case finding.
• The developed tool is effective in optimizing HIV testing strategies for children and adolescents.