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Brief Report: Pediatric Saliva-Based HIV Testing: Health care Worker and Caregiver Acceptability
Jillian Neary1, Michelle A Bulterys1, Emily A Ogutu2
1Department of Epidemiology, University of Washington, Seattle, WA.
Insights
Pediatric HIV testing using saliva-based tests (SBT) is acceptable to healthcare workers and caregivers. This approach shows promise for increasing HIV testing coverage in children.
Area of Science:
- Public Health
- Pediatric Medicine
- HIV/AIDS Research
Background:
- Pediatric HIV testing rates are suboptimal, necessitating improved strategies.
- Saliva-based testing (SBT) is validated for children aged 18 months and older.
- Understanding caregiver and healthcare worker (HCW) acceptance is key for implementing pediatric SBT.
Purpose of the Study:
- To assess the acceptability of pediatric saliva-based testing (SBT) among caregivers and healthcare workers (HCWs).
- To explore the perceived benefits and challenges of both facility-based and home-based pediatric SBT.
Main Methods:
- Conducted 8 focus group discussions (4 with HCWs, 4 with caregivers) in western Kenya.
- Explored acceptability and use of pediatric SBT, including home- and facility-based scenarios.
- Utilized qualitative thematic analysis of transcribed discussions.
Main Results:
- Initial concerns about HIV transmission via saliva were alleviated after demonstration.
- Benefits included ease of use, avoiding finger pricks, reduced wait times (facility), and convenience/privacy (home).
- Challenges included ensuring confidentiality, access to counseling, partner agreement, and emotional responses to results.
Conclusions:
- Saliva-based testing (SBT) is generally acceptable to both HCWs and caregivers for pediatric HIV testing.
- Pediatric SBT is a promising strategy to enhance HIV testing coverage in children.
- HCWs saw limited utility for unsupervised home-based SBT, while caregivers desired accessible counseling.
Background:
Pediatric HIV testing remains suboptimal. The OraQuick test [saliva-based test (SBT)] is validated in pediatric populations ≥18 months. Understanding caregiver and health care worker (HCW) acceptability of pediatric SBT is critical for implementation.
Methods:
A trained qualitative interviewer conducted 8 focus group discussions (FGDs): 4 with HCWs and 4 with caregivers of children seeking health services in western Kenya. FGDs explored acceptability of pediatric SBT and home- and facility-based SBT use. Two reviewers conducted consensus coding and thematic analyses of transcripts using Dedoose.
Results:
Most HCWs but few caregivers had heard of SBT. Before seeing SBT instructions, both had concerns about potential HIV transmission through saliva, which were mostly alleviated after kit demonstration. Noted benefits of SBT included usability and avoiding finger pricks. Benefits of facility-based pediatric SBT included shorter client waiting and service time, higher testing coverage, and access to HCWs, while noted challenges included ensuring confidentiality. Benefits of caregivers using home-based SBT included convenience, privacy, decreased travel costs, increased testing, easier administration, and child comfort. Perceived challenges included not receiving counseling, disagreements with partners, child neglect, and negative emotional response to a positive test result. Overall, HCWs felt that SBT could be used for pediatric HIV testing but saw limited utility for caregivers performing SBT without an HCW present. Caregivers saw utility in home-based SBT but wanted easy access to counseling in case of a positive test result.
Conclusions:
SBT was generally acceptable to HCWs and caregivers and is a promising strategy to expand testing coverage.
