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Updated: Jul 6, 2025
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Optimizing HIV case identification among children and understanding remaining gaps in pediatric HIV testing in
Dominique Ingala1, Winnie Bakebua2, Fideline Banzadio2
1Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa, Democratic Republic of Congo. dingala@pedaids.org.
Insights
Early HIV identification and treatment are crucial for children. This study found a 6.7% HIV positivity rate in children through contact tracing, highlighting the need for improved testing and resource allocation.
Area of Science:
- Pediatric infectious diseases
- Public health initiatives
- HIV/AIDS epidemiology
Background:
- Early identification and antiretroviral treatment (ART) are critical for children living with HIV.
- The Pediatric Accelerated Case Finding Effort focused on HIV testing of ART clients' biological children through contact elicitation.
- This study aimed to describe HIV testing rates, seropositivity, and identify gaps in pediatric HIV case finding.
Purpose of the Study:
- To evaluate the effectiveness of the Pediatric Accelerated Case Finding Effort in identifying and testing children for HIV.
- To determine HIV testing and seropositivity rates among biological children of ART clients.
- To identify bottlenecks in the pediatric HIV testing cascade to optimize case finding strategies.
Main Methods:
- A mixed-methods approach was used, collecting monthly data from March 2020 to July 2021 in 35 facilities in Kinshasa.
- Quantitative data included index testing outcomes: elicitation, HIV testing, and linkage to treatment.
- Qualitative data involved in-depth interviews with healthcare workers and focus group discussions with community health workers, analyzed thematically.
Main Results:
- By July 2021, 11,734 eligible clients had contacts identified, with 83.3% (9871/11,848) HIV-tested.
- A 6.7% (662/9871) HIV positivity rate was observed among tested contacts, with 80.8% (535/662) aged 5-14 years; 99.5% initiated ART.
- Primary gaps included testing refusals due to non-disclosure, logistical/financial obstacles, and COVID-19 restrictions; strategies included transport reimbursement and counseling.
Conclusions:
- Intensified pediatric case finding yielded a high HIV positivity rate of 6.7% among previously undiagnosed children, predominantly older children (≥5 years).
- Contact tracing for HIV testing represented the most significant gap, missing opportunities to reach 17% of undiagnosed children.
- Optimizing pediatric case finding requires adequate resources for tracing and testing, support for couple disclosure, and continued focus on eliciting ART clients' biological children.
Background:
It is critical to identify children living with HIV and initiate lifesaving antiretroviral treatment (ART) early. The Pediatric Accelerated Case Finding Effort focused on contact elicitation and HIV testing of ART clients' biological children. We describe HIV testing and seropositivity rates following the initiative and gaps along the index testing cascade to inform pediatric HIV case finding optimization.
Methods:
This mixed-methods study involved collecting monthly data on index testing outcomes, including elicitation (identifying biological children < 15 years), HIV testing and linkage to treatment from March 2020 to July 2021 in 35 facilities in Kinshasa. Data were summarized and presented for the first month (as a baseline proxy) and the entire study period. Qualitative data were collected from 14 healthcare workers participating in in-depth interviews and 33 community health workers in four focus group discussions. Audio recordings were transcribed and translated from Lingala or French into English and coded using MAXQDA software. Data were thematically analyzed according pediatric case finding barriers and strategies.
Results:
At baseline (March 2020), among 3337 eligible female index clients, 1634 (49.0%) underwent elicitation to identify children with unknown HIV status. By July 2021, all eligible clients (n = 11,734) had contacts identified. Of the contacts, 9871/11,848 (83.3%) were HIV-tested. Of contacts tested, 662 (6.7%) were diagnosed as HIV-positive, with 535 (80.8%) age 5-14 years; 99.5% initiated treatment. Providers attributed gaps in HIV testing primarily to testing refusals for children due to non-disclosure among parents and logistical or financial obstacles to transportation for tracing. COVID-19 movement restrictions and exposure fears also limited provider interactions for testing. Provider-implemented strategies included transport reimbursement, extensive counseling and alternative approaches to child testing for parents in sero-discordant relationships.
Conclusions:
Following intensified efforts around pediatric case finding, we found a high HIV positivity yield of 6.7% among previously undiagnosed children, with 81% of them aged ≥5 years. While elicitation improved over time, contact tracing for HIV testing remained the largest gap, missing opportunities to reach 17% of undiagnosed children. Ensuring adequate resources for tracing and HIV testing and supporting disclosure among couples, while emphasizing elicitation of ART clients' biological children can help to optimize pediatric case finding.
