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Developing and Validating an Effective Pediatric and Adolescent HIV Testing Eligibility Screening Tool for
Cordelia Katureebe1, Kim Ashburn2, Rhoderick Machekano2
1Uganda Ministry of Health, Kampala, Uganda.
Insights
Developing a new pediatric HIV screening tool improves testing efficiency for children. This tool identifies children needing HIV tests with high accuracy, reducing the number needed to test (NNT).
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.
Introduction:
Because of low pediatric HIV prevalence, more tests are needed to find 1 HIV-positive child compared with adults. In Uganda, the number needed to test (NNT) to find 1 new HIV-positive child was 64 in outpatient departments (OPDs) and 31 through index testing. We aimed to develop and validate a pediatric (1.5-14 years) screening tool to optimize testing approaches.
Methods:
Phase 1 evaluated the performance of 10 screening questions in 14 OPDs using a variable selection algorithm to evaluate combinations of screening questions. Using logistic regression, we identified the number of screening questions with the best predictive accuracy using the receiver operation characteristic curve. Phase 2 validated the proposed tool in 15 OPDs and 7 orphan and vulnerable children programs. We estimated sensitivity, specificity, and NNT accounting for intercluster correlations.
Results:
A total of 3482 children were enrolled. The optimal model included reported HIV-positive maternal status or 2/5 symptoms (sickly in the last 3 months, recurring skin problems, weight loss, not growing well, and history of tuberculosis). The proposed tool had sensitivity of 83.6% [95% confidence interval (CI): 68.1 to 92.4] and specificity of 62.5% (95% CI: 55.0 to 69.4). The tool was validated in a sample of 11,342 children; sensitivity was 87.8% (95% CI: 80.9 to 92.5) and specificity 62.6% (95% CI: 54.8 to 69.7) across OPDs and community sites. In OPDs, sensitivity was 88.1% (95% CI: 80.8 to 92.8) and specificity 69.0% (95% CI: 61.9 to 75.3). The NNT was 43 (95% CI: 28 to 67) across settings and 28 (95% CI: 20 to 38) for OPD.
Conclusions:
This HIV screening tool has high sensitivity and reasonable specificity, increasing testing efficiency and yield for children and adolescents.
