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Index-Linked Assisted HIV Self-Testing for Children 2-14 Years: Results of a Pilot Evaluation in Ethiopia
Yoseph Gutema1, Sileshi Lulseged1, Mirtie Getachew2
1ICAP at Columbia University, Addis Ababa, Ethiopia.
Insights
Home HIV self-testing (HIVST) for children is acceptable and feasible in Ethiopia. This strategy successfully identified children living with HIV, aiding case finding and progress towards global health targets.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- HIV/AIDS Research
Background:
- Pediatric HIV case identification is crucial for achieving global 95-95-95 targets.
- Oral mucosal HIV self-testing (HIVST) for children over 2 years is WHO-approved, but data on its use in Ethiopia is limited.
Purpose of the Study:
- To assess the acceptability and feasibility of using HIVST kits by parents/caregivers for home-based screening of children aged 2-14 years in Ethiopia.
- To evaluate HIVST as a strategy for pediatric case identification in a low-prevalence setting.
Main Methods:
- A pilot program was conducted across nine Ethiopian health facilities from November 2021 to April 2022.
- HIV-positive adult index clients received HIVST kits to test their children at home, with results reported telephonically.
- Acceptability and feasibility were defined by specific thresholds for test acceptance, result reporting, confirmatory testing, and social harms.
Main Results:
- 91% of parents/caregivers accepted HIVST kits, and 71% reported results within 7 days.
- Of 17 children with reactive HIVST results, 76% received confirmatory testing, identifying 7 new pediatric HIV cases (54% of those tested).
- One serious social harm was reported among 1000 kits distributed.
Conclusions:
- Home-based HIVST by parents/caregivers is an acceptable and feasible approach for identifying children with unknown HIV status in Ethiopia.
- This strategy shows promise for improving pediatric case finding and contributing to the elimination of pediatric HIV.
Background:
Case identification remains a challenge to reaching the United Nations 95-95-95 targets for children with HIV. Although the World Health Organization approved oral mucosal HIV self-testing (HIVST) for children older than 2 years in 2019, there is little information on HIVST for pediatric case identification in Ethiopia.
Setting:
Nine health facilities across Ethiopia.
Methods:
We implemented a pilot program from November 2021 to April 2022 to assess acceptability and feasibility of using HIVST to screen children 2-14 years of adult index clients, (ie, parents/caregivers living with HIV and on antiretroviral therapy). HIV-positive adults who had children with unknown HIV status were given HIVST kits (OraQuick) to screen their children at home. Parents/caregivers were asked to report results telephonically and bring children screening positive to the health facility for confirmatory HIV testing. We defined HIVST acceptability as ≥50% of parents/caregivers accepting testing and ≥50% reporting results within 7 days of receiving a test kit. Feasibility was defined as ≥60% of children with a reactive HIVST receiving confirmatory testing and <5 serious social harms reported per 1000 kits distributed.
Results:
Overall, 1496 of 1651 (91%) parents/caregivers accepted HIVST kits to test their children at home and 1204 (71%) reported results within 7 days. Of 17 children (1%) with reactive results, 13 (76%) received confirmatory testing; of which 7 (54%) were confirmed to be HIV positive. One serious social harm was reported.
Conclusions:
Providing adult parents/caregivers with HIVST kits to screen their children at home is an acceptable and feasible strategy to reach untested children and improve pediatric case finding in a low prevalence setting.
