Related Experiment Video
Updated: Sep 22, 2025
An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
Published on: March 30, 2014
Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk
Wondimu Teferi1, Steve Gutreuter2, Alemayehu Bekele3
1Centers for Disease Control and Prevention, US Embassy Entoto Road, P.O.B 1014, Addis Ababa, Ethiopia. ipk6@cdc.gov.
Insights
Developing new HIV screening tools for children in Ethiopia significantly improves testing efficiency at malnutrition and inpatient entry points. These tools maintain case identification while reducing the number needed to test for pediatric antiretroviral therapy.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- HIV/AIDS research
Background:
- Effective case-finding is crucial for increasing pediatric antiretroviral therapy coverage.
- Current HIV testing strategies in Ethiopia show low positivity rates at specific entry points, necessitating strategy reassessment.
- The study focuses on improving HIV case identification among children in low-prevalence settings.
Purpose of the Study:
- To develop and evaluate an HIV risk screening tool for children (2-14 years) at inpatient, malnutrition, and orphans and vulnerable children (OVC) entry points in Ethiopia.
- To enhance the efficiency of HIV case-finding strategies in resource-limited settings.
- To provide a practical tool for identifying children living with HIV (CLHIV) in Ethiopia.
Main Methods:
- The study was conducted in 29 public health facilities in Ethiopia from May 2017 to March 2018.
- Data were collected through registers, medical records, and caregiver interviews for children aged 2-14 years.
- HIV screening tools were developed using logistic regression and an unweighted method, assessing sensitivity, specificity, and number needed to test (NNT).
Main Results:
- Screening tools demonstrated high sensitivity (95%) for identifying children living with HIV (CLHIV).
- Logistic regression-derived tools showed higher specificity (61.4-65.6%) compared to the unweighted method (53.6%).
- The developed tools could reduce the number needed to test (NNT) by 58-63% compared to universal testing, while maintaining case identification.
Conclusions:
- HIV screening tools developed using logistic regression can significantly improve testing efficiency in Ethiopian pediatric care settings.
- These simplified tools maintain case identification and are practical for implementation at various entry points.
- The tools offer a potential model for HIV programs in other low-prevalence countries to optimize case-finding strategies.
Background:
Implementing effective and efficient case-finding strategies is crucial to increasing pediatric antiretroviral therapy coverage. In Ethiopia, universal HIV testing is conducted for children presenting at high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC); however, low positivity rates observed at inpatient, malnutrition and OVC entry points warrant re-assessing current case-finding strategies. The aim of this study is to develop HIV risk screening tool applicable for testing children presenting at inpatient, malnutrition and OVC entry points in low-HIV prevalence settings.
Methods:
The study was conducted from May 2017-March 2018 at 29 public health facilities in Amhara and Addis Ababa regions of Ethiopia. All children 2-14 years presenting to five high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC) were enrolled after consent. Data were collected from registers, medical records, and caregiver interviews. Screening tools were constructed using predictors of HIV positivity as screening items by applying both logistic regression and an unweighted method. Sensitivity, specificity and number needed to test (NNT) to identify one new child living with HIV (CLHIV) were estimated for each tool.
Results:
The screening tools had similar sensitivity of 95%. However, the specificities of tools produced by logistic regression methods (61.4 and 65.6%) which are practically applicable were higher than those achieved by the unweighted method (53.6). Applying these tools could result in 58‒63% reduction in the NNT compared to universal testing approach while maintaining the overall number of CLHIV identified.
Conclusion:
The screening tools developed using logistic regression method could significantly improve HIV testing efficiency among children presenting to malnutrition, inpatient, and OVC entry points in Ethiopia while maintaining case identification. These tools are simplified to practically implement and can potentially be validated for use at various entry points. HIV programs in low-prevalence countries can also further investigate and optimize these tools in their settings.
Related Concept Videos
01:26Sexually Transmitted Infections
01:10Retrovirus Life Cycles